Direct admission versus secondary transfer for acute ischemic stroke patients treated with thrombectomy: a systematic review and meta-analysis.
Direct admission
Mechanical thrombectomy
Meta-analysis
Secondary transfer
Stroke
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
05
04
2020
accepted:
29
04
2020
revised:
28
04
2020
pubmed:
5
6
2020
medline:
29
9
2021
entrez:
5
6
2020
Statut:
ppublish
Résumé
Randomized controlled trials have demonstrated that mechanical thrombectomy (MT) could provide more benefit than standard medical care for acute ischemic stroke (AIS) patients due to emergent large vessel occlusion. However, most primary stroke centers (PSCs) are unable to perform MT, and MT can only be performed in comprehensive stroke centers (CSCs) with on-site interventional neuroradiologic services. Therefore, there is an ongoing debate regarding whether patients with suspected AIS should be directly admitted to CSCs or secondarily transferred to CSCs from PSCs. This meta-analysis was aimed to investigate the two transportation paradigms of direct admission and secondary transfer, which one could provide more benefit for AIS patients treated with MT. We conducted a systematic review and meta-analysis through searching PubMed, Embase and the Cochrane Library database up to March 2020. Primary outcomes are as follows: symptomatic intracerebral hemorrhage (sICH) within 7 days; favorable functional outcome at 3 months; mortality in hospital; mortality at 3 months; and successful recanalization rate. Our pooled results showed that patients directly admitted to CSCs had higher chances of achieving a favorable functional outcome at 3 months than those secondarily transferred to CSCs (OR = 1.26; 95% CI, 1.12-1.42; P < 0.001). In addition, no significant difference was found between the two transportation paradigms in the rate of sICH (OR = 0.86; 95% CI, 0.62-1.18; P = 0.35), mortality in hospital (OR = 0.84; 95% CI, 0.51-1.39; P = 0.51), mortality at 3 months (OR = 1.01; 95% CI, 0.85-1.21; P = 0.91), and successful recanalization (OR = 1.03; 95% CI, 0.88-1.20; P = 0.74). However, in the 100% bridging thrombolysis usage rate subgroup, our subgroup analysis indicated that no difference was found in any outcome between the two transportation paradigms. Patients with AIS directly admitted to CSCs for MT may be a feasible transportation paradigm for AIS patients. However, more large-scale randomized prospective trials are required to further investigate this issue.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Randomized controlled trials have demonstrated that mechanical thrombectomy (MT) could provide more benefit than standard medical care for acute ischemic stroke (AIS) patients due to emergent large vessel occlusion. However, most primary stroke centers (PSCs) are unable to perform MT, and MT can only be performed in comprehensive stroke centers (CSCs) with on-site interventional neuroradiologic services. Therefore, there is an ongoing debate regarding whether patients with suspected AIS should be directly admitted to CSCs or secondarily transferred to CSCs from PSCs. This meta-analysis was aimed to investigate the two transportation paradigms of direct admission and secondary transfer, which one could provide more benefit for AIS patients treated with MT.
METHODS
METHODS
We conducted a systematic review and meta-analysis through searching PubMed, Embase and the Cochrane Library database up to March 2020. Primary outcomes are as follows: symptomatic intracerebral hemorrhage (sICH) within 7 days; favorable functional outcome at 3 months; mortality in hospital; mortality at 3 months; and successful recanalization rate.
RESULTS
RESULTS
Our pooled results showed that patients directly admitted to CSCs had higher chances of achieving a favorable functional outcome at 3 months than those secondarily transferred to CSCs (OR = 1.26; 95% CI, 1.12-1.42; P < 0.001). In addition, no significant difference was found between the two transportation paradigms in the rate of sICH (OR = 0.86; 95% CI, 0.62-1.18; P = 0.35), mortality in hospital (OR = 0.84; 95% CI, 0.51-1.39; P = 0.51), mortality at 3 months (OR = 1.01; 95% CI, 0.85-1.21; P = 0.91), and successful recanalization (OR = 1.03; 95% CI, 0.88-1.20; P = 0.74). However, in the 100% bridging thrombolysis usage rate subgroup, our subgroup analysis indicated that no difference was found in any outcome between the two transportation paradigms.
CONCLUSION
CONCLUSIONS
Patients with AIS directly admitted to CSCs for MT may be a feasible transportation paradigm for AIS patients. However, more large-scale randomized prospective trials are required to further investigate this issue.
Identifiants
pubmed: 32494852
doi: 10.1007/s00415-020-09877-2
pii: 10.1007/s00415-020-09877-2
doi:
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
3601-3609Informations de copyright
© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Berkhemer OA et al (2015) A randomized trial of intraarterial treatment for acute ischemic stroke. New England J Med 372:11–20. https://doi.org/10.1056/NEJMoa1411587
doi: 10.1056/NEJMoa1411587
Campbell BCV et al (2015) Endovascular therapy for ischemic stroke with perfusion-imaging selection. New England J Med 372:1009–1018. https://doi.org/10.1056/NEJMoa1414792
doi: 10.1056/NEJMoa1414792
Goyal M et al (2015) Randomized assessment of rapid endovascular treatment of ischemic stroke. New England J Med 372:1019–1030. https://doi.org/10.1056/NEJMoa1414905
doi: 10.1056/NEJMoa1414905
Saver JL et al (2015) Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. New England J Med 372:2285–2295. https://doi.org/10.1056/NEJMoa1415061
doi: 10.1056/NEJMoa1415061
Jovin TG et al (2015) Thrombectomy within 8 hours after symptom onset in ischemic stroke. New England J Med 372:2296–2306. https://doi.org/10.1056/NEJMoa1503780
doi: 10.1056/NEJMoa1503780
Goyal M et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (London, England) 387:1723–1731. https://doi.org/10.1016/S0140-6736(16)00163-X
doi: 10.1016/S0140-6736(16)00163-X
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. https://doi.org/10.1371/journal.pmed.1000097
doi: 10.1371/journal.pmed.1000097
pubmed: 19621072
pmcid: 2707599
Adams KM et al (2019) Outcomes after Thrombectomy in Belfast: Mothership and Drip-and-Ship in the Real World. Cerebrovasc Dis 47:231–237. https://doi.org/10.1159/000500849
doi: 10.1159/000500849
pubmed: 31212294
Asaithambi G et al (2018) Real-world treatment of large vessel occlusions: combined outcomes of directly presenting and transferred-in patients to a stroke center. Neurol Res 40:637–643. https://doi.org/10.1080/01616412.2018.1460700
doi: 10.1080/01616412.2018.1460700
pubmed: 29683786
Barlinn J et al (2017) Acute endovascular treatment delivery to ischemic stroke patients transferred within a telestroke network: a retrospective observational study. Int J Stroke 12:502–509. https://doi.org/10.1177/1747493016681018
doi: 10.1177/1747493016681018
pubmed: 27899742
Bücke P et al (2018) Endovascular Thrombectomy in Acute Ischemic Stroke: Outcome in Referred Versus Directly Admitted Patients. Clin Neuroradiol 28:235–244. https://doi.org/10.1007/s00062-017-0558-z
doi: 10.1007/s00062-017-0558-z
pubmed: 28144702
Feil K et al (2020) Drip and ship for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria. Neurology 94:e453–e463. https://doi.org/10.1212/WNL.0000000000008753
doi: 10.1212/WNL.0000000000008753
pubmed: 31831595
Froehler MT et al (2017) Interhospital Transfer Before Thrombectomy Is Associated With Delayed Treatment and Worse Outcome in the STRATIS Registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke). Circulation 136:2311–2321. https://doi.org/10.1161/circulationaha.117.028920
doi: 10.1161/circulationaha.117.028920
pubmed: 28943516
pmcid: 5732640
Gerschenfeld G et al (2017) Two Paradigms for Endovascular Thrombectomy After Intravenous Thrombolysis for Acute Ischemic Stroke. JAMA Neurol 74:549–556. https://doi.org/10.1001/jamaneurol.2016.5823
doi: 10.1001/jamaneurol.2016.5823
pubmed: 28319240
pmcid: 5822198
Hiyama N et al (2016) Safety and effectiveness of drip, ship, and retrieve paradigm for acute ischemic stroke: A single center experience. Neurol Med Chir 56:731–736. https://doi.org/10.2176/nmc.oa.2016-0102
doi: 10.2176/nmc.oa.2016-0102
Jayaraman MV et al (2020) Field triage for endovascular stroke therapy: a population-based comparison. J Neurointervent Surg 12:233–239. https://doi.org/10.1136/neurintsurg-2019-015033
doi: 10.1136/neurintsurg-2019-015033
Drip PMS et al (2016) ship, and on-demand endovascular therapy for acute ischemic stroke. PLoS ONE. https://doi.org/10.1371/journal.pone.0150668
doi: 10.1371/journal.pone.0150668
Prothmann S et al (2017) Acute Recanalization of Thrombo-Embolic Ischemic Stroke with pREset (ARTESp): the impact of occlusion time on clinical outcome of directly admitted and transferred patients. J Neurointervent Surg 9:817–822. https://doi.org/10.1136/neurintsurg-2016-012556
doi: 10.1136/neurintsurg-2016-012556
Rinaldo L et al (2017) Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke. J Neurointervent Surg 9:1166–1172. https://doi.org/10.1136/neurintsurg-2016-012824
doi: 10.1136/neurintsurg-2016-012824
Sarraj A et al (2019) Outcomes of thrombectomy in transferred patients with ischemic stroke in the late window: A subanalysis from the defuse 3 trial. JAMA Neurol 76:682–689. https://doi.org/10.1001/jamaneurol.2019.0118
doi: 10.1001/jamaneurol.2019.0118
pubmed: 30734042
pmcid: 6563543
Seker F et al (2019) Direct Admission vs. Secondary Transfer to a Comprehensive Stroke Center for Thrombectomy: Retrospective Analysis of a Regional Stroke Registry with 2797 Patients. Clin Neuroradiol. https://doi.org/10.1007/s00062-019-00842-9
doi: 10.1007/s00062-019-00842-9
pubmed: 31781803
Shigeta K et al (2019) Widening time disparities between two paradigms: tama-registry of acute endovascular thrombectomy. J Stroke Cerebrovascular Dis 28:1267–1273. https://doi.org/10.1016/j.jstrokecerebrovasdis.2019.01.021
doi: 10.1016/j.jstrokecerebrovasdis.2019.01.021
Van Veenendaal P et al (2018) Endovascular clot retrieval by hub-and-spoke service delivery is feasible compared with direct-to-mothership. Cerebrovasc Dis 46:170–175. https://doi.org/10.1159/000490421
doi: 10.1159/000490421
Weber R et al (2016) Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy. Therapeut Adv Neurol Dis 9:79–84. https://doi.org/10.1177/1756285615617081
doi: 10.1177/1756285615617081
Weisenburger-Lile D et al (2019) Direct admission versus secondary transfer for acute stroke patients treated with intravenous thrombolysis and thrombectomy: Insights from the endovascular treatment in ischemic stroke registry. Cerebrovasc Dis 47:112–120. https://doi.org/10.1159/000499112
doi: 10.1159/000499112
pubmed: 31063998
Saver JL et al (2015) Stent-retriever thrombectomy after intravenous t-PA vs t-PA alone in stroke. New England J Med 372:2285–2295. https://doi.org/10.1056/NEJMoa1415061
doi: 10.1056/NEJMoa1415061
Mansoor S, Zand R, Al-Wafai A, Wahba MN, Giraldo EA (2013) Safety of a "drip and ship" intravenous thrombolysis protocol for patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 22:969–971. https://doi.org/10.1016/j.jstrokecerebrovasdis.2011.12.010
doi: 10.1016/j.jstrokecerebrovasdis.2011.12.010
pubmed: 22306381
Qureshi AI et al (2012) Outcome of the 'Drip-and-Ship' Paradigm among Patients with Acute Ischemic Stroke: Results of a Statewide Study. Cerebrovasc Diseases Extra 2:1–8
doi: 10.1159/000335097
Silverman IE, Beland DK, Chhabra J, McCullough LD (2005) The, "drip-and-ship" approach: starting IV t-PA for acute ischemic stroke at outside hospitals prior to transfer to a regional stroke center. Conn Med 69:613–620
pubmed: 16381108
Tekle WG et al (2012) Drip-and-ship thrombolytic treatment paradigm among acute ischemic stroke patients in the United States. Stroke 43:1971–1974. https://doi.org/10.1161/STROKEAHA.112.657817
doi: 10.1161/STROKEAHA.112.657817
pubmed: 22669407
Saver JL et al (2016) Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA 316:1279–1288. https://doi.org/10.1001/jama.2016.13647
doi: 10.1001/jama.2016.13647
pubmed: 27673305
pmcid: 27673305
Goyal M et al (2016) Analysis of Workflow and Time to Treatment and the Effects on Outcome in Endovascular Treatment of Acute Ischemic Stroke: Results from the SWIFT PRIME Randomized Controlled Trial. Radiology 279:888–897. https://doi.org/10.1148/radiol.2016160204
doi: 10.1148/radiol.2016160204
pubmed: 27092472
Fan L et al (2020) Outcomes of mechanical thrombectomy with pre-intravenous thrombolysis: a systematic review and meta-analysis. J Neurol. https://doi.org/10.1007/s00415-020-09778-4
doi: 10.1007/s00415-020-09778-4
pubmed: 32839839
Mistry EA et al (2017) Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis. Stroke 48:2450–2456. https://doi.org/10.1161/STROKEAHA.117.017320
doi: 10.1161/STROKEAHA.117.017320
pubmed: 28747462
Broeg-Morvay A et al (2016) Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke: A Matched-Pairs Analysis. Stroke 47:1037–1044. https://doi.org/10.1161/STROKEAHA.115.011134
doi: 10.1161/STROKEAHA.115.011134
pubmed: 26906917
Whiteley WN et al (2016) Risk of intracerebral haemorrhage with alteplase after acute ischaemic stroke: a secondary analysis of an individual patient data meta-analysis. Lancet Neurol 15:925–933. https://doi.org/10.1016/s1474-4422(16)30076-x
doi: 10.1016/s1474-4422(16)30076-x
pubmed: 27289487
Lees KR et al (2010) Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375:1695–1703. https://doi.org/10.1016/s0140-6736(10)60491-6
doi: 10.1016/s0140-6736(10)60491-6
pubmed: 20472172
Jansen IGH, Mulder M, Goldhoorn RB (2018) Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry). BMJ Clin Res. https://doi.org/10.1136/bmj.k949
doi: 10.1136/bmj.k949
van Meenen LCC et al (2020) Interhospital transfer vs direct presentation of patients with a large vessel occlusion not eligible for IV thrombolysis. J Neurol. https://doi.org/10.1007/s00415-020-09812-5
doi: 10.1007/s00415-020-09812-5
pubmed: 32266543
pmcid: 7320925
Rodríguez-Pardo J et al (2020) Prehospital selection of thrombectomy candidates beyond large vessel occlusion: M-DIRECT scale. Neurology. https://doi.org/10.1212/WNL.0000000000008998
doi: 10.1212/WNL.0000000000008998
pubmed: 32651090
Turc G (2017) Mothership or drip-and-ship in the era of thrombectomy: can we use prehospital clinical scales as a compass? Eur J Neurol 24:543–544. https://doi.org/10.1111/ene.13261
doi: 10.1111/ene.13261
pubmed: 28251721