Hassan Ameer E, Zaidat Osama O, Nanda Ashish, Atchie Benjamin, Woodward Keith, Doerfler Arnd, Tomasello Alejandro, Fifi Johanna T
Valley Baptist Medical Center, Neuroscience Department, University of Texas Rio Grande Valley, Harlingen, TX, United States.
Endovascular Neurology and Neuroscience, Mercy Health St. Vincent Medical Center, Toledo, OH, United States.
Front Neurol. 2022 Aug 9;13:896165. doi: 10.3389/fneur.2022.896165. eCollection 2022.
Efficacy of thrombectomy treatment in acute ischemic stroke large vessel occlusion (AIS-LVO) patients is time dependent. Direct admission to thrombectomy centers (vs. interhospital transfer) may reduce time to treatment and improve outcomes. In this subset analysis of the COMPLETE registry, we compared outcomes between direct to thrombectomy center (Direct) vs. transfer from another hospital to thrombectomy center (Transfer) in AIS-LVO patients treated with aspiration thrombectomy.
COMPLETE was a prospective, international registry that enrolled patients from July 2018 to October 2019, with a 90-day follow-up period that was completed in January 2020. Imaging findings and safety events were adjudicated by core lab and independent medical reviewers, respectively. Pre-defined primary endpoints included post-procedure angiographic revascularization (mTICI ≥2b), 90-day functional outcome (mRS 0-2), and 90-day all-cause mortality. Planned collections of procedural time metrics and outcomes were used in the present analysis to compare outcomes between transfer and direct patient cohorts.
Of 650 patients enrolled, 343 were transfer [52.8% female; mean (SD) age, 68.2 (13.9) years], and 307 were direct [55.4% female; 68.5 (14.5) years] admit. Median onset-to-puncture time took longer in the transfer vs. direct cohort (5.65 vs. 3.18 h: 2.33 h difference, respectively; < 0.001). There was no significant difference in successful revascularization rate, mTICI ≥2b (88.3 and 87.3%), sICH at 24 h (3.8 and 3.9%), median length of hospital stay (7 and 6 days), and 90-day mortality (16.9 and 14.0%) between transfer vs. direct patients, respectively. However, achieving 90-day functional independence was less likely in transfer compared with direct patients (mRS 0-2 was 50.3 vs. 61.7%, = 0.0056).
In the COMPLETE registry, direct to thrombectomy center was associated with significantly shorter onset-to-puncture times, and higher rates of good clinical outcome across different geographies. Additional research should focus on AIS-LVO detection to facilitate direct routing of patients to appropriate treatment centers.
https://clinicaltrials.gov (Unique identifier: NCT03464565).
急性缺血性卒中大血管闭塞（AIS-LVO）患者的血栓切除术治疗效果具有时间依赖性。直接入住血栓切除术中心（与院间转运相比）可能会减少治疗时间并改善预后。在这项COMPLETE注册研究的亚组分析中，我们比较了直接入住血栓切除术中心（直接组）与从另一家医院转运至血栓切除术中心（转运组）的接受取栓治疗的AIS-LVO患者的预后。
COMPLETE是一项前瞻性国际注册研究，于2018年7月至2019年10月招募患者，随访期为90天，于2020年1月完成。影像学检查结果和安全事件分别由核心实验室和独立医学评审员判定。预定义的主要终点包括术后血管造影再通（mTICI≥2b）、90天功能预后（mRS 0-2）和90天全因死亡率。本分析使用计划收集的手术时间指标和预后数据来比较转运组和直接组患者的预后。
在650名登记患者中，343名是转运组患者[女性占52.8%；平均（标准差）年龄为68.2（13.9）岁]，307名是直接组患者[女性占55.4%；68.5（14.5）岁]。转运组的中位发病至穿刺时间比直接组更长（分别为5.65小时和3.18小时：相差2.33小时；P<0.001）。转运组和直接组患者在成功再通率、mTICI≥2b（分别为88.3%和87.3%）、24小时内症状性颅内出血（分别为3.8%和3.9%）、中位住院时间（分别为7天和6天）以及90天死亡率（分别为16.9%和14.0%）方面均无显著差异。然而，与直接组患者相比，转运组患者在90天时实现功能独立的可能性较小（mRS 0-2分别为50.3%和61.7%，P = 0.0056）。
在COMPLETE注册研究中，直接入住血栓切除术中心与显著更短的发病至穿刺时间相关，并且在不同地区均有更高的良好临床预后率。进一步的研究应聚焦于AIS-LVO的检测，以促进患者直接转诊至合适的治疗中心。
