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Ther Adv Neurol Disord. 2016 Mar;9(2):79-84. doi: 10.1177/1756285615617081. Epub 2015 Nov 26.

Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy.

Author information

1
Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany.
2
Department of Neurology, Klinikum Dortmund, Germany.
3
Department of Neurology, University Hospital of Duisburg-Essen, Germany.
4
Institute of Epidemiology and Social Medicine, University of M√ľnster, Germany.
5
Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Germany.
6
Department of Neurology, Alfried Krupp Krankenhaus Essen, Germany.
7
Department of Radiology and Neuroradiology, Klinikum Duisburg, Germany.
8
Department of Neurology, Klinikum Bergmannsheil Bochum, Germany.
9
Department of Neurology, St Josef-Hospital Bochum, Germany.
10
Neuroradiology, Klinikum Vest Recklinghausen and Knappschaftskrankenhaus Bochum, Germany.
11
Department of Neurology, St Josef Krankenhaus Moers, Germany.
12
Department of Neurology, Knappschaftskrankenhaus Bochum, Germany.

Abstract

BACKGROUND:

After thrombectomy has shown to be effective in acute stroke patients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated.

AIMS:

We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit.

METHODS:

Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients.

RESULTS:

In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0-2, 44.0% versus 35.7%, p = 0.08).

CONCLUSIONS:

Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in stroke patients eligible for thrombectomy after initial brain imaging.

KEYWORDS:

functional outcome; ischemic stroke; mortality; periprocedural times; referral status; thrombectomy

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