Scripties UMCG - Rijksuniversiteit Groningen
English | Nederlands

Transfer for acute stroke patients from primary to comprehensive stroke centers does not delay treatment or influence clinical outcome

(2019) Alhelali, J. (Jehan)

Background: The benefit of endovascular treatment by means of Intra-arterial thrombectomy in
acute ischemic stroke (AIS) with large artery occlusion (LAO) was largely recognized.
However, thrombectomy is known to be highly complex and hence it is only offered in
comprehensive stroke centers (CSC) and not in primary stroke center (PSC). In this regard,
several organizational referral models to deliver treatment have been developed. Most widely
used are the so called “drip and ship(DS)” and “mothership models(MS)”. Aim: Our aim was
to evaluate the neurological outcome and safety of Intra-arterial thrombectomy patients who
are initially admitted to PSC and later shipped to CSC to start the thrombectomy (DS) in
compare to patients directly admitted to CSC (MS). Methods: we retrospectively analyzed
109 MS patients and 187 DS patients who were admitted for Intra-arterial thrombectomy.
Functional outcome (90-mRS), complication, mortality rate and workflow times were
assessed. Results: Despite the significantly faster initiation of intravenous treatment of DS
patients, there was no significant different in functional outcome (90- Modified Rankin Scale
for Disability mRS) between both groups (0-2, P = .494). likewise, symptomatic intracerebral
hemorrhage rate (3.7% DS vs 8.3%, P = .114) and both short term mortality (7 % DS vs
12.8% MS, P =.098) and long-term mortality rate (4.3% DS vs 6.6 %, P = .777) were not
significant different. Conclusion: Our study conclude that the DS paradigm is safe and
feasible for AIS patients with LAO, with no statistically significant difference in comparison
to MS patients in regards to functional outcome and adverse events.

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