David Weisenburger-Lile1, Raphaël Blanc2, Maeva Kyheng3, Jean-Philippe Desilles2, Julien Labreuche3, Michel Piotin2, Mikael Mazighi2,4, Arturo Consoli5, Bertrand Lapergue1,6, Benjamin Gory7,8. 1. Department of Neurology, Stroke Center, Foch Hospital, Suresnes, France. 2. Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France. 3. University Lille, CHU Lille, EA 2694, Santé Publique: épidémiologie et Qualité des Soins, Lille, France. 4. University Paris Denis Diderot, Paris, France. 5. Department of Diagnostic and Interventional Neuroradiology, Hopital Foch, Suresnes, France. 6. Université Versailles Saint-Quentin en Yvelines et Paris Saclay, Paris, France. 7. Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France, benjagory@gmail.com. 8. University of Lorraine, INSERM U1254, IADI, Nancy, France, benjagory@gmail.com.
Abstract
BACKGROUND: To date, thrombectomy for large vessel occlusion (LVO) strokes can be performed only in comprehensive stroke centers with thrombectomy capacity. We compared the clinical outcome of patients first referred to a primary stroke center to those admitted directly to a comprehensive stroke center and treated on site in the multicentric observational Endovascular Treatment in Ischemic Stroke (ETIS) registry. METHODS: From our perspective, multicenter, observational ETIS registry, we analyzed anterior circulation stroke patients, treated within 8 h, who underwent thrombectomy after thrombolysis and were admitted to a comprehensive stroke center either with drip and ship or mothership. Clinical and safety outcomes were compared between 2 groups. RESULTS: A total of 971 patients were analyzed: 298 were treated with the mothership approach and 673 with drip and ship. Significantly more functional independence (90-day modified Rankin Scale [mRS] 0-2) was achieved in mothership (60.1%) than in drip and ship patients (52.6%; adjusted relative risk [RR] 0.87, 95% CI 0.77-0.98, p = 0.018). Excellent outcome (90-day mRS 0-1) was achieved in 45.3% of the mothership group, compared to 37.9% of the drip and ship group (RR 0.84, 95% CI 0.71-0.98; p = 0.026). According to the distance between the primary stroke center and the comprehensive stroke center, greater functional independence was achieved in mothership than in drip and ship >12.5 miles patients (adjusted RR 0.82; 95% CI 0.71-0.94). Results in the drip-ship group stratified according to time between cerebral imaging and groin puncture (categorized according to the median cut-off: 140 min) were similar. Symptomatic intracerebral hemorrhage rate and mortality within 90 days was similar in both groups (7.5 vs. 5.9%, p = 0.40; 17.4 vs. 16.1%, p = 0.63). CONCLUSIONS: Our study suggests that LVO stroke patients directly admitted to a comprehensive stroke center present a higher chance of functional independence, especially when the distance between the primary stroke center and comprehensive stroke center is >12.5 miles or when the time between cerebral imaging and groin puncture is ≥140 min.
BACKGROUND: To date, thrombectomy for large vessel occlusion (LVO) strokes can be performed only in comprehensive stroke centers with thrombectomy capacity. We compared the clinical outcome of patients first referred to a primary stroke center to those admitted directly to a comprehensive stroke center and treated on site in the multicentric observational Endovascular Treatment in Ischemic Stroke (ETIS) registry. METHODS: From our perspective, multicenter, observational ETIS registry, we analyzed anterior circulation strokepatients, treated within 8 h, who underwent thrombectomy after thrombolysis and were admitted to a comprehensive stroke center either with drip and ship or mothership. Clinical and safety outcomes were compared between 2 groups. RESULTS: A total of 971 patients were analyzed: 298 were treated with the mothership approach and 673 with drip and ship. Significantly more functional independence (90-day modified Rankin Scale [mRS] 0-2) was achieved in mothership (60.1%) than in drip and shippatients (52.6%; adjusted relative risk [RR] 0.87, 95% CI 0.77-0.98, p = 0.018). Excellent outcome (90-day mRS 0-1) was achieved in 45.3% of the mothership group, compared to 37.9% of the drip and ship group (RR 0.84, 95% CI 0.71-0.98; p = 0.026). According to the distance between the primary stroke center and the comprehensive stroke center, greater functional independence was achieved in mothership than in drip and ship >12.5 miles patients (adjusted RR 0.82; 95% CI 0.71-0.94). Results in the drip-ship group stratified according to time between cerebral imaging and groin puncture (categorized according to the median cut-off: 140 min) were similar. Symptomatic intracerebral hemorrhage rate and mortality within 90 days was similar in both groups (7.5 vs. 5.9%, p = 0.40; 17.4 vs. 16.1%, p = 0.63). CONCLUSIONS: Our study suggests that LVO strokepatients directly admitted to a comprehensive stroke center present a higher chance of functional independence, especially when the distance between the primary stroke center and comprehensive stroke center is >12.5 miles or when the time between cerebral imaging and groin puncture is ≥140 min.
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Authors: Ameer E Hassan; Osama O Zaidat; Ashish Nanda; Benjamin Atchie; Keith Woodward; Arnd Doerfler; Alejandro Tomasello; Johanna T Fifi Journal: Front Neurol Date: 2022-08-09 Impact factor: 4.086