PMID- 28536177
OWN - NLM
STAT- MEDLINE
DCOM- 20170719
LR  - 20180307
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 48
IP  - 7
DP  - 2017 Jul
TI  - Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic
      Stroke Patients Undergoing Thrombectomy.
PG  - 1884-1889
LID - 10.1161/STROKEAHA.117.016946 [doi]
AB  - BACKGROUND AND PURPOSE: In patients identified at referring facilities with acute
      ischemic stroke caused by a large vessel occlusion, bypassing the emergency
      department (ED) with direct transport to the neuroangiography suite may safely
      shorten reperfusion times. METHODS: We conducted a single-center retrospective
      review of consecutive patients transferred to our facility for consideration of
      endovascular therapy. Patients were identified as admitted directly to the
      neuroangiography suite (DAN), transferred to the ED before intra-arterial therapy
      (ED-IA), and transferred to the ED but did not receive IA therapy (ED-IV).
      RESULTS: A retrospective review of a prospectively maintained database of
      transfer patients between January 2013 and October 2016 with large vessel
      occlusions identified 108 ED-IV patients and 261 patients who underwent
      mechanical thrombectomy (DAN=111 patients and ED-IA=150 patients). There were no 
      differences in baseline characteristics among the 3 groups. The median computed
      tomography ASPECTS (Alberta Stroke Program Early CT Score) was lower in the ED-IV
      group versus the ED-IA and DAN groups (8 versus 9; P=0.001). In the DAN versus
      ED-IA cohort, there were comparable rates of TICI2b/3 recanalization and access
      to recanalization time. There was significantly faster hospital arrival to groin 
      access time in the DAN cohort (81 minutes versus 22 minutes; P=0.001). Functional
      independence at 90 days was comparable in the DAN versus ED-IA cohorts but worse 
      in the ED-IV group (43% versus 44% versus 22%; P=0.001). CONCLUSIONS: DAN is
      safe, feasible, and associated with faster times of hospital arrival to
      recanalization. The clinical benefit of this approach should be assessed in a
      prospective randomized trial.
CI  - (c) 2017 American Heart Association, Inc.
FAU - Jadhav, Ashutosh P
AU  - Jadhav AP
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Kenmuir, Cynthia L
AU  - Kenmuir CL
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Aghaebrahim, Amin
AU  - Aghaebrahim A
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Limaye, Kaustubh
AU  - Limaye K
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Wechsler, Lawrence R
AU  - Wechsler LR
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Hammer, Maxim D
AU  - Hammer MD
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Starr, Matthew T
AU  - Starr MT
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Molyneaux, Bradley J
AU  - Molyneaux BJ
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Rocha, Marcelo
AU  - Rocha M
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Guyette, Francis X
AU  - Guyette FX
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Martin-Gill, Christian
AU  - Martin-Gill C
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Ducruet, Andrew F
AU  - Ducruet AF
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Gross, Bradley A
AU  - Gross BA
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Jankowitz, Brian T
AU  - Jankowitz BT
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
FAU - Jovin, Tudor G
AU  - Jovin TG
AD  - From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S.,
      B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J.,
      B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.),
      and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh 
      Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and 
      Barrow Neurological Institute, Phoenix, AZ (A.F.D.). jovitg@upmc.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170523
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
SB  - IM
CIN - Stroke. 2017 Oct;48(10 ):e314. PMID: 28887389
CIN - Stroke. 2017 Oct;48(10 ):e316. PMID: 28887390
CIN - Stroke. 2017 Oct;48(10 ):e315. PMID: 28887394
CIN - Stroke. 2017 Oct;48(10 ):e313. PMID: 28887395
MH  - Aftercare
MH  - Aged
MH  - Brain Ischemia/mortality/*therapy
MH  - Cerebral Angiography/*statistics & numerical data
MH  - Emergency Service, Hospital/*statistics & numerical data
MH  - Endovascular Procedures/*statistics & numerical data
MH  - Humans
MH  - Mechanical Thrombolysis/*statistics & numerical data
MH  - Middle Aged
MH  - Outcome and Process Assessment (Health Care)/*statistics & numerical data
MH  - Patient Admission/*statistics & numerical data
MH  - Patient Transfer/*statistics & numerical data
MH  - Retrospective Studies
MH  - Stroke/mortality/*therapy
MH  - Time Factors
MH  - Triage/statistics & numerical data
OTO - NOTNLM
OT  - *emergency medicine
OT  - *reperfusion
OT  - *stroke
OT  - *triage
OT  - *workflow
EDAT- 2017/05/26 06:00
MHDA- 2017/07/20 06:00
CRDT- 2017/05/25 06:00
PHST- 2017/02/12 00:00 [received]
PHST- 2017/04/11 00:00 [revised]
PHST- 2017/04/27 00:00 [accepted]
PHST- 2017/05/26 06:00 [pubmed]
PHST- 2017/07/20 06:00 [medline]
PHST- 2017/05/25 06:00 [entrez]
AID - STROKEAHA.117.016946 [pii]
AID - 10.1161/STROKEAHA.117.016946 [doi]
PST - ppublish
SO  - Stroke. 2017 Jul;48(7):1884-1889. doi: 10.1161/STROKEAHA.117.016946. Epub 2017
      May 23.