Blanca Fuentes1, María Alonso de Leciñana2, Alvaro Ximénez-Carrillo2, Patricia Martínez-Sánchez2, Antonio Cruz-Culebras2, Gustavo Zapata-Wainberg2, Gerardo Ruiz-Ares2, Remedios Frutos2, Eduardo Fandiño2, Jose L Caniego2, Andrés Fernández-Prieto2, Jose C Méndez2, Eduardo Bárcena2, Begoña Marín2, Andrés García-Pastor2, Fernando Díaz-Otero2, Antonio Gil-Núñez2, Jaime Masjuán2, Jose Vivancos2, Exuperio Díez-Tejedor2. 1. From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.). blanca.fuentes@salud.madrid.org. 2. From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
Abstract
BACKGROUND AND PURPOSE: The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke and the small number of patients eligible for treatment justify the development of stroke center networks with interhospital patient transfers. However, this approach might result in futile transfers (ie, the transfer of patients who ultimately do not undergo ERT). Our aim was to analyze the frequency of these futile transfers and the reasons for discarding ERT and to identify the possible associated factors. METHODS: We analyzed an observational prospective ERT registry from a stroke collaboration ERT network consisting of 3 hospitals. There were interhospital transfers from the first attending hospital to the on-call ERT center for the patients for whom this therapy was indicated, either primarily or after intravenous thrombolysis (drip and shift). RESULTS: The ERT protocol was activated for 199 patients, 129 of whom underwent ERT (64.8%). A total of 120 (60.3%) patients required a hospital transfer, 50 of whom (41%) ultimately did not undergo ERT. There were no differences in their baseline characteristics, the times from stroke onset, or in the delays in interhospital transfers between the transferred patients who were treated and those who were not treated. The main reasons for rejecting ERT after the interhospital transfer were clinical improvement/arterial recanalization (48%) and neuroimaging criteria (32%). CONCLUSIONS: Forty-one percent of the ERT transfers were futile, but none of the baseline patient characteristics predicted this result. Futility could be reduced if repetition of unnecessary diagnostic tests was avoided.
BACKGROUND AND PURPOSE: The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke and the small number of patients eligible for treatment justify the development of stroke center networks with interhospital patient transfers. However, this approach might result in futile transfers (ie, the transfer of patients who ultimately do not undergo ERT). Our aim was to analyze the frequency of these futile transfers and the reasons for discarding ERT and to identify the possible associated factors. METHODS: We analyzed an observational prospective ERT registry from a stroke collaboration ERT network consisting of 3 hospitals. There were interhospital transfers from the first attending hospital to the on-call ERT center for the patients for whom this therapy was indicated, either primarily or after intravenous thrombolysis (drip and shift). RESULTS: The ERT protocol was activated for 199 patients, 129 of whom underwent ERT (64.8%). A total of 120 (60.3%) patients required a hospital transfer, 50 of whom (41%) ultimately did not undergo ERT. There were no differences in their baseline characteristics, the times from stroke onset, or in the delays in interhospital transfers between the transferred patients who were treated and those who were not treated. The main reasons for rejecting ERT after the interhospital transfer were clinical improvement/arterial recanalization (48%) and neuroimaging criteria (32%). CONCLUSIONS: Forty-one percent of the ERT transfers were futile, but none of the baseline patient characteristics predicted this result. Futility could be reduced if repetition of unnecessary diagnostic tests was avoided.
Authors: Benjamin P George; Sara J Doyle; George P Albert; Ania Busza; Robert G Holloway; Kevin N Sheth; Adam G Kelly Journal: Neurology Date: 2018-04-04 Impact factor: 9.910
Authors: Carmen Serna Candel; Marta Aguilar Pérez; Victoria Hellstern; Muhammad AlMatter; Hansjörg Bäzner; Hans Henkes Journal: Cerebrovasc Dis Date: 2019-11-20 Impact factor: 2.762
Authors: Gregoire Boulouis; Arne Lauer; Ahmer Khawdja Siddiqui; Andreas Charidimou; Robert W Regenhardt; Anand Viswanathan; Natalia Rost; Thabele M Leslie-Mazwi; Lee H Schwamm Journal: JAMA Neurol Date: 2017-11-01 Impact factor: 18.302
Authors: Neal S Parikh; Abhinaba Chatterjee; Iván Díaz; Ankur Pandya; Alexander E Merkler; Gino Gialdini; Benjamin R Kummer; Saad A Mir; Michael P Lerario; Matthew E Fink; Babak B Navi; Hooman Kamel Journal: Stroke Date: 2018-01-17 Impact factor: 7.914
Authors: Bijoy K Menon; Fahad S Al-Ajlan; Mohamed Najm; Josep Puig; Mar Castellanos; Dar Dowlatshahi; Ana Calleja; Sung-Il Sohn; Seong H Ahn; Alex Poppe; Robert Mikulik; Negar Asdaghi; Thalia S Field; Albert Jin; Talip Asil; Jean-Martin Boulanger; Eric E Smith; Shelagh B Coutts; Phil A Barber; Simerpreet Bal; Suresh Subramanian; Sachin Mishra; Anurag Trivedi; Sadanand Dey; Muneer Eesa; Tolulope Sajobi; Mayank Goyal; Michael D Hill; Andrew M Demchuk Journal: JAMA Date: 2018-09-11 Impact factor: 56.272
Authors: Ali Z Nomani; Joseph Kamtchum Tatuene; Jeremy L Rempel; Thomas Jeerakathil; Ian R Winship; Khurshid A Khan; Brian H Buck; Ashfaq Shuaib; Glen C Jickling Journal: Neurology Date: 2021-10-04 Impact factor: 9.910
Authors: Kori S Zachrison; Thabele M Leslie-Mazwi; Gregoire Boulouis; Joshua N Goldstein; Robert W Regenhardt; Anand Viswanathan; Arne Lauer; Khawdja Ahmer Siddiqui; Andreas Charidimou; Natalia Rost; Lee H Schwamm Journal: Neurol Clin Pract Date: 2019-10