Interhospital Transfer for Endovascular Stroke Treatment in Canada: Results From the OPTIMISE Registry.

BACKGROUND

Interhospital transfer for patients with stroke due to large vessel occlusion for endovascular thrombectomy (EVT) has been associated with treatment delays.

METHODS

We analyzed data from Optimizing Patient Treatment in Major Ischemic Stroke With EVT, a quality improvement registry to support EVT implementation in Canada. We assessed for unadjusted differences in baseline characteristics, time metrics, and procedural outcomes between patients with large vessel occlusion transferred for EVT and those directly admitted to an EVT-capable center.

RESULTS

Between January 1, 2018, and December 31, 2021, a total of 6803 patients received EVT at 20 participating centers (median age, 73 years; 50% women; and 50% treated with intravenous thrombolysis). Patients transferred for EVT (n=3376) had lower rates of M2 occlusion (22% versus 27%) and higher rates of basilar occlusion (9% versus 5%) compared with those patients presenting directly at an EVT-capable center (n=3373). Door-to-needle times were shorter in patients receiving intravenous thrombolysis before transfer compared with those presenting directly to an EVT center (32 versus 36 minutes). Patients transferred for EVT had shorter door-to-arterial access times (37 versus 87 minutes) but longer last seen normal-to-arterial access times (322 versus 181 minutes) compared with those presenting directly to an EVT-capable center. No differences in arterial access-to-reperfusion times, successful reperfusion rates (85% versus 86%), or adverse periprocedural events were found between the 2 groups. Patients transferred to EVT centers had a similar likelihood for good functional outcome (modified Rankin Scale score, 0-2; 41% versus 43%; risk ratio, 0.95 [95% CI, 0.88-1.01]; adjusted risk ratio, 0.98 [95% CI, 0.91-1.05]) and a higher risk for all-cause mortality at 90 days (29% versus 25%; risk ratio, 1.15 [95% CI, 1.05-1.27]; adjusted risk ratio, 1.14 [95% CI, 1.03-1.28]) compared with patients presenting directly to an EVT center.

CONCLUSIONS

Patients transferred for EVT experience significant delays from the time they were last seen normal to the initiation of EVT.

Déclaration de conflit d'intérêts

Alexandre Poppe reports grants from the Canadian Institutes of Health Research, compensation from Roche for other services, and grants from the Fondation Brain Canada, the Heart and Stroke Foundation of Canada, and Stryker. Dr Swartz reports grants from the Heart and Stroke Foundation of Canada, compensation from the Sunnybrook Research Institute for other services, compensation from F. Hoffmann-La Roche for consultant services, stock holdings in FollowMD, Inc, and grants from the Ontario Brain Institute and the National Institutes of Health. Dr Catanese reports compensation from Hoffmann-La Roche Limited for consultant services, employment by Hamilton Health Sciences, and grants from Servier Pharmaceuticals LLC. Dr Volders reports compensation from Penumbra, Inc, for consultant services. Dr Kelly reports compensation from Johnson and Johnson, Penumbra, Inc, and Medtronic Vascular, Inc, for consultant services. Dr Kamal reports stock holdings in DESTINE Health and compensation from Medtronic for consultant services. Dr Yu reports grants from the Canadian Institutes of Health Research. Dr Hill reports grants from NoNO, Inc, and Medtronic, compensation from Brainsgate Ltd for consultant services, grants from the Canadian Institutes of Health Research; Medtronic, Boehringer Ingelheim, Medtronic, and MicroVention, Inc, and compensation from Merck for end point review committee services. Dr Sharma reports grants from Bristol Myers Squibb Company to others and compensation from Bayer and AstraZeneca for consultant services. Dr Demchuk reports compensation from Hoffmann-La Roche Limited for consultant services, compensation from Lumosa for data and safety monitoring services, a patent issued for Stroke imaging software licensed to Circle NVI, compensation from Boehringer Ingelheim for consultant services, compensation from Novo Nordisk AS for other services, compensation from Philips for data and safety monitoring services, compensation from NovaSignal for consultant services, and stock holdings in Circle NVI.