Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K., L.C., A.S., M.S.).
Department of Neurosciences, Université de Montréal and Centre Hospitalier de l'Université de Montréal, QC, Canada (A. Poppe).
Stroke. 2024 Aug;55(8):2103-2112. doi: 10.1161/STROKEAHA.124.046690. Epub 2024 Jul 22.
Interhospital transfer for patients with stroke due to large vessel occlusion for endovascular thrombectomy (EVT) has been associated with treatment delays.
We analyzed data from Optimizing Patient Treatment in Major Ischemic Stroke With EVT, a quality improvement registry to support EVT implementation in Canada. We assessed for unadjusted differences in baseline characteristics, time metrics, and procedural outcomes between patients with large vessel occlusion transferred for EVT and those directly admitted to an EVT-capable center.
Between January 1, 2018, and December 31, 2021, a total of 6803 patients received EVT at 20 participating centers (median age, 73 years; 50% women; and 50% treated with intravenous thrombolysis). Patients transferred for EVT (n=3376) had lower rates of M2 occlusion (22% versus 27%) and higher rates of basilar occlusion (9% versus 5%) compared with those patients presenting directly at an EVT-capable center (n=3373). Door-to-needle times were shorter in patients receiving intravenous thrombolysis before transfer compared with those presenting directly to an EVT center (32 versus 36 minutes). Patients transferred for EVT had shorter door-to-arterial access times (37 versus 87 minutes) but longer last seen normal-to-arterial access times (322 versus 181 minutes) compared with those presenting directly to an EVT-capable center. No differences in arterial access-to-reperfusion times, successful reperfusion rates (85% versus 86%), or adverse periprocedural events were found between the 2 groups. Patients transferred to EVT centers had a similar likelihood for good functional outcome (modified Rankin Scale score, 0-2; 41% versus 43%; risk ratio, 0.95 [95% CI, 0.88-1.01]; adjusted risk ratio, 0.98 [95% CI, 0.91-1.05]) and a higher risk for all-cause mortality at 90 days (29% versus 25%; risk ratio, 1.15 [95% CI, 1.05-1.27]; adjusted risk ratio, 1.14 [95% CI, 1.03-1.28]) compared with patients presenting directly to an EVT center.
Patients transferred for EVT experience significant delays from the time they were last seen normal to the initiation of EVT.
由于大血管闭塞而行血管内血栓切除术（EVT）的卒中患者进行医院间转运会导致治疗延误。
我们分析了优化患者治疗的大血管闭塞性缺血性卒中介入治疗的质量改进登记处的数据，以支持加拿大 EVT 的实施。我们评估了大血管闭塞性卒中患者在接受 EVT 治疗前进行转院和直接转至 EVT 中心治疗的基线特征、时间指标和治疗结局方面的差异。
2021 年 1 月 1 日至 12 月 31 日期间，共有 6803 名患者在 20 个参与中心接受 EVT 治疗（中位年龄 73 岁，50%为女性，50%接受静脉溶栓治疗）。与直接在 EVT 中心就诊的患者（n=3373）相比，转院接受 EVT 治疗的患者（n=3376）M2 闭塞的发生率较低（22% vs. 27%），基底动脉闭塞的发生率较高（9% vs. 5%）。与直接到 EVT 中心就诊的患者相比，在转院前接受静脉溶栓治疗的患者的门到针时间更短（32 分钟 vs. 36 分钟）。与直接到 EVT 中心就诊的患者相比，转院患者的门到动脉入路时间更短（37 分钟 vs. 87 分钟），但最后一次正常到动脉入路时间更长（322 分钟 vs. 181 分钟）。两组患者的动脉入路到再灌注时间、成功再灌注率（85% vs. 86%）或围手术期不良事件无差异。与直接在 EVT 中心就诊的患者相比，转院至 EVT 中心的患者有相似的获得良好功能结局的可能性（改良 Rankin 量表评分 0-2，41% vs. 43%；风险比，0.95 [95%CI，0.88-1.01]；调整风险比，0.98 [95%CI，0.91-1.05]），90 天全因死亡率风险更高（29% vs. 25%；风险比，1.15 [95%CI，1.05-1.27]；调整风险比，1.14 [95%CI，1.03-1.28]）。
接受 EVT 治疗的患者从最后一次正常到开始 EVT 的时间经历了显著的延迟。
