Stroke: Vascular and Interventional Neurology (Nov 2022)

Direct to Angio‐Suite Large Vessel Occlusion Stroke Transfers Achieve Faster Arrival‐to‐Puncture Times and Improved Outcomes

  • Robert W. Regenhardt,
  • Joseph A. Rosenthal,
  • Adam A. Dmytriw,
  • Justin E. Vranic,
  • Anna K. Bonkhoff,
  • Martin Bretzner,
  • Joshua A. Hirsch,
  • James D. Rabinov,
  • Christopher J. Stapleton,
  • Aman B. Patel,
  • Aneesh B. Singhal,
  • Natalia S. Rost,
  • Thabele M. Leslie‐Mazwi,
  • Mark R. Etherton

DOI
https://doi.org/10.1161/SVIN.121.000327
Journal volume & issue
Vol. 2, no. 6

Abstract

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Background For patients with large vessel occlusion (LVO) stroke, time to treatment with endovascular thrombectomy is crucial to prevent infarction and improve outcomes. We sought to evaluate the hub arrival‐to‐puncture times and outcomes for transferred patients accepted directly to the angio‐suite (LVO to operating room, LVO2OR) versus those accepted through the emergency department in a hub‐and‐spoke telestroke network. Methods Consecutive patients transferred for endovascular thrombectomy with spoke computed tomography angiography–confirmed LVO, spoke Alberta Stroke Program Early Computed Tomography score >6, and last known well–to–hub arrival <6 hours were identified. Our LVO2OR protocol began implementation in January 2017. The LVO2OR cohort includes patients who underwent endovascular thrombectomy from July 2017 to October 2020; the emergency department cohort includes those from January 2011 to December 2016. Hub arrival‐to‐puncture time and 90‐day modified Rankin scale score were prospectively recorded. Results The LVO2OR cohort was composed of 91 patients, and the emergency department cohort was composed of 90 patients. LVO2OR patients had more atrial fibrillation (51% versus 32%; P=0.02) and more M2 occlusions (27% versus 10%; P=0.01). LVO2OR patients had faster median hub arrival‐to‐puncture time (11 versus 92 minutes; P<0.001), faster median telestroke consult‐to‐puncture time (2.4 versus 3.6 hours; P<0.001), greater Thrombolysis in Cerebral Infarction score 2b to 3 reperfusion (92% versus 69%; P<0.001), and greater 90‐day modified Rankin scale score <2 (35% versus 21%; P=0.04). In a multivariable model, LVO2OR significantly increased the odds of 90‐day modified Rankin scale score <2 (adjusted odds ratio, 2.77 [95% CI, 1.07–7.20]; P=0.04) even when controlling for age, baseline modified Rankin scale score, atrial fibrillation, National Institutes of Health Stroke Scale score, M2 occlusion location, and Thrombolysis in Cerebral Infarction score 2b to 3. Conclusions In a hub‐and‐spoke telestroke network, accepting transferred patients directly to the angio‐suite was associated with dramatically reduced hub arrival‐to‐puncture time and may lead to improved 90‐day outcomes. Direct–to–angio‐suite protocols should continue to be evaluated in other geographic regions and telestroke network models.

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