Jacob R Morey1, Neha S Dangayach1,2, Hazem Shoirah1, Jacopo Scaggiante1, J Mocco1, Stanley Tuhrim2, Johanna T Fifi3,4. 1. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 2. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA. 3. Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA, johanna.fifi@mountsinai.org. 4. Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA, johanna.fifi@mountsinai.org.
Abstract
INTRODUCTION: Endovascular therapy (EVT) has emerged as the standard of care for emergent large vessel occlusion (ELVO) acute ischemic stroke. An increasing number of patients with suspected ELVO are being transferred to stroke centers with interventional capacity. Not all such inter-hospital transfers result in EVT. AIM: To identify the major causes for not performing EVT following transfer. METHODS: An analysis of 222 consecutive patients with suspected ELVO transferred for potential EVT between January 2015 and -December 2017 within a New York City health system was performed. About 36% (80/222) were deemed EVT ineligible and compared to an EVT cohort. RESULTS: Major causes for not performing EVT were established infarct (34%), no or recanalized ELVO (31%), and mild or clinically improved symptoms (21%). In the established infarct subgroup, 28% (7/27) arrived at a stroke center with interventional capacity within 5 h of last known well, compared to 61% (83/142) in the EVT cohort (p = 0.003). In the no or recanalized ELVO subgroup, 40% (10/25) received computed tomographic angiography at the primary stroke center (PSC), compared to 73% (104/142) in the EVT cohort (p = 0.001). Among patients treated with intravenous thrombolysis, 6% (6/104) improved from a NIHSS of ≥6 to <6 following transfer. CONCLUSIONS: Established infarct, no or recanalized ELVO, and mild or clinically improved symptoms were the major causes for not performing EVT for patients transferred for ELVO management. These may be addressed by decreasing stroke onset to treatment times and timely ELVO detection at the PSC and/or pre-hospital triage.
INTRODUCTION: Endovascular therapy (EVT) has emerged as the standard of care for emergent large vessel occlusion (ELVO) acute ischemic stroke. An increasing number of patients with suspected ELVO are being transferred to stroke centers with interventional capacity. Not all such inter-hospital transfers result in EVT. AIM: To identify the major causes for not performing EVT following transfer. METHODS: An analysis of 222 consecutive patients with suspected ELVO transferred for potential EVT between January 2015 and -December 2017 within a New York City health system was performed. About 36% (80/222) were deemed EVT ineligible and compared to an EVT cohort. RESULTS: Major causes for not performing EVT were established infarct (34%), no or recanalized ELVO (31%), and mild or clinically improved symptoms (21%). In the established infarct subgroup, 28% (7/27) arrived at a stroke center with interventional capacity within 5 h of last known well, compared to 61% (83/142) in the EVT cohort (p = 0.003). In the no or recanalized ELVO subgroup, 40% (10/25) received computed tomographic angiography at the primary stroke center (PSC), compared to 73% (104/142) in the EVT cohort (p = 0.001). Among patients treated with intravenous thrombolysis, 6% (6/104) improved from a NIHSS of ≥6 to <6 following transfer. CONCLUSIONS: Established infarct, no or recanalized ELVO, and mild or clinically improved symptoms were the major causes for not performing EVT for patients transferred for ELVO management. These may be addressed by decreasing stroke onset to treatment times and timely ELVO detection at the PSC and/or pre-hospital triage.
Keywords:
Acute ischemic stroke; Emergent large vessel occlusion; Hospital transfer; Mechanical thrombectomy; Stroke facilities; Stroke systems of care
Authors: Eyal Klang; Benjamin R Kummer; Neha S Dangayach; Amy Zhong; M Arash Kia; Prem Timsina; Ian Cossentino; Anthony B Costa; Matthew A Levin; Eric K Oermann Journal: Sci Rep Date: 2021-01-14 Impact factor: 4.379
Authors: Katharina Feil; Jan Rémi; Clemens Küpper; Moriz Herzberg; Franziska Dorn; Wolfgang G Kunz; Paul Reidler; Johannes Levin; Katrin Hüttemann; Steffen Tiedt; Wanja Heidger; Katharina Müller; Dennis C Thunstedt; Rainer Dabitz; Robert Müller; Thomas Pfefferkorn; Gerhard F Hamann; Thomas Liebig; Marianne Dieterich; Lars Kellert Journal: J Neurol Date: 2020-09-05 Impact factor: 4.849