Aristeidis H Katsanos, Alexandre Poppe, Rick H Swartz, Jennifer Mandzia, Luciana Catanese, Jai Shankar, Samuel Yip, Steve Verreault, George Medvedev, Ilavarasy Maran, Catherine Legault, Darren Ferguson, Brian Archer, Aditya Bharatha, David Volders, Michael Kelly, Federico Carpani, Aleksandra Pikula, Alexander Tkach, Francois Moreau, Michel Beaudry, Ramana Appireddy, Aviraj Deshmukh, Mohammed Almekhlafi, Robert Fahed, Noreen Kamal, Bijoy Menon, Ashkan Shoamanesh, Heather Williams, Amy Y X Yu, Manraj K S Heran, Michael D Hill, Mukul Sharma, Karen Earl, Andrew M Demchuk, Grant Stotts
{"title":"加拿大脑卒中血管内治疗的院际转运：OPTIMISE 登记的结果。","authors":"Aristeidis H Katsanos, Alexandre Poppe, Rick H Swartz, Jennifer Mandzia, Luciana Catanese, Jai Shankar, Samuel Yip, Steve Verreault, George Medvedev, Ilavarasy Maran, Catherine Legault, Darren Ferguson, Brian Archer, Aditya Bharatha, David Volders, Michael Kelly, Federico Carpani, Aleksandra Pikula, Alexander Tkach, Francois Moreau, Michel Beaudry, Ramana Appireddy, Aviraj Deshmukh, Mohammed Almekhlafi, Robert Fahed, Noreen Kamal, Bijoy Menon, Ashkan Shoamanesh, Heather Williams, Amy Y X Yu, Manraj K S Heran, Michael D Hill, Mukul Sharma, Karen Earl, Andrew M Demchuk, Grant Stotts","doi":"10.1161/STROKEAHA.124.046690","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Interhospital transfer for patients with stroke due to large vessel occlusion for endovascular thrombectomy (EVT) has been associated with treatment delays.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Patients transferred for EVT experience significant delays from the time they were last seen normal to the initiation of EVT.</p>","PeriodicalId":21989,"journal":{"name":"Stroke","volume":null,"pages":null},"PeriodicalIF":7.8000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Interhospital Transfer for Endovascular Stroke Treatment in Canada: Results From the OPTIMISE Registry.\",\"authors\":\"Aristeidis H Katsanos, Alexandre Poppe, Rick H Swartz, Jennifer Mandzia, Luciana Catanese, Jai Shankar, Samuel Yip, Steve Verreault, George Medvedev, Ilavarasy Maran, Catherine Legault, Darren Ferguson, Brian Archer, Aditya Bharatha, David Volders, Michael Kelly, Federico Carpani, Aleksandra Pikula, Alexander Tkach, Francois Moreau, Michel Beaudry, Ramana Appireddy, Aviraj Deshmukh, Mohammed Almekhlafi, Robert Fahed, Noreen Kamal, Bijoy Menon, Ashkan Shoamanesh, Heather Williams, Amy Y X Yu, Manraj K S Heran, Michael D Hill, Mukul Sharma, Karen Earl, Andrew M Demchuk, Grant Stotts\",\"doi\":\"10.1161/STROKEAHA.124.046690\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Interhospital transfer for patients with stroke due to large vessel occlusion for endovascular thrombectomy (EVT) has been associated with treatment delays.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Patients transferred for EVT experience significant delays from the time they were last seen normal to the initiation of EVT.</p>\",\"PeriodicalId\":21989,\"journal\":{\"name\":\"Stroke\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":7.8000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Stroke\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/STROKEAHA.124.046690\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/22 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/STROKEAHA.124.046690","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/22 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
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.
期刊介绍：
Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery.
The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists.
Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.
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