Ralph Weber1, Gernot Reimann2, Christian Weimar3, Angela Winkler3, Klaus Berger4, Hannes Nordmeyer5, Jeffrie Hadisurya6, Friedhelm Brassel7, Martin Kitzrow8, Christos Krogias9, Werner Weber10, Elmar W Busch11, Jens Eyding12. 1. Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany. 2. Department of Neurology, Klinikum Dortmund, Germany. 3. Department of Neurology, University Hospital of Duisburg-Essen, Germany. 4. Institute of Epidemiology and Social Medicine, University of Münster, Germany. 5. Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Germany. 6. Department of Neurology, Alfried Krupp Krankenhaus Essen, Germany. 7. Department of Radiology and Neuroradiology, Klinikum Duisburg, Germany. 8. Department of Neurology, Klinikum Bergmannsheil Bochum, Germany. 9. Department of Neurology, St Josef-Hospital Bochum, Germany. 10. Neuroradiology, Klinikum Vest Recklinghausen and Knappschaftskrankenhaus Bochum, Germany. 11. Department of Neurology, St Josef Krankenhaus Moers, Germany. 12. Department of Neurology, Knappschaftskrankenhaus Bochum, Germany.
Abstract
BACKGROUND: After thrombectomy has shown to be effective in acute stroke patients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated. AIMS: We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit. METHODS: Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients. RESULTS: In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0-2, 44.0% versus 35.7%, p = 0.08). CONCLUSIONS: Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in stroke patients eligible for thrombectomy after initial brain imaging.
BACKGROUND: After thrombectomy has shown to be effective in acute strokepatients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated. AIMS: We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit. METHODS: Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients. RESULTS: In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0-2, 44.0% versus 35.7%, p = 0.08). CONCLUSIONS: Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in strokepatients eligible for thrombectomy after initial brain imaging.
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