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- Title
Interhospital transfer vs. direct presentation of patients with a large vessel occlusion not eligible for IV thrombolysis.
- Authors
van Meenen, Laura C. C.; Groot, Adrien E.; Venema, Esmee; Emmer, Bart J.; Smeekes, Martin D.; Kommer, Geert Jan; Majoie, Charles B. L. M.; Roos, Yvo B. W. E. M.; Schonewille, Wouter J.; Roozenbeek, Bob; Coutinho, Jonathan M.; the MR CLEAN Registry Investigators; Dippel, Diederik W. J.; van der Lugt, Aad; van Oostenbrugge, Robert J.; van Zwam, Wim H.; Boiten, Jelis; Vos, Jan Albert; Brouwer, Josje; den Hartog, Sanne J.
- Abstract
Background and purpose: Direct presentation of patients with acute ischemic stroke to a comprehensive stroke center (CSC) reduces time to endovascular treatment (EVT), but may increase time to treatment for intravenous thrombolysis (IVT). This dilemma, however, is not applicable to patients who have a contraindication for IVT. We examined the effect of direct presentation to a CSC on outcomes after EVT in patients not eligible for IVT. Methods: We used data from the MR CLEAN Registry (2014–2017). We included patients who were not treated with IVT and compared patients directly presented to a CSC to patients transferred from a primary stroke center. Outcomes included treatment times and 90-day modified Rankin Scale scores (mRS) adjusted for potential confounders. Results: Of the 3637 patients, 680 (19%) did not receive IVT and were included in the analyses. Of these, 389 (57%) were directly presented to a CSC. The most common contraindications for IVT were anticoagulation use (49%) and presentation > 4.5 h after onset (26%). Directly presented patients had lower baseline NIHSS scores (median 16 vs. 17, p = 0.015), higher onset-to-first-door times (median 105 vs. 66 min, p < 0.001), lower first-door-to-groin times (median 93 vs. 150 min; adjusted β = − 51.6, 95% CI: − 64.0 to − 39.2) and lower onset-to-groin times (median 220 vs. 230 min; adjusted β = − 44.0, 95% CI: − 65.5 to − 22.4). The 90-day mRS score did not differ between groups (adjusted OR: 1.23, 95% CI: 0.73–2.08). Conclusions: In patients who were not eligible for IVT, treatment times for EVT were better for patients directly presented to a CSC, but without a statistically significant effect on clinical outcome.
- Subjects
STROKE patients; ENDOVASCULAR surgery
- Publication
Journal of Neurology, 2020, Vol 267, Issue 7, p2142
- ISSN
0340-5354
- Publication type
Article
- DOI
10.1007/s00415-020-09812-5