Title

Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy

Authors

Ashutosh P. Jadhav, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Cynthia L. Kenmuir, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Amin Aghaebrahim, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Kaustubh Limaye, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Lawrence R. Wechsler, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Maxim D. Hammer, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Matthew T. Starr, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Bradley J. Molyneaux, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Marcelo Rocha, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Francis X. Guyette, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Christian Martin-Gill, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Andrew F. Ducruet, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).Follow
Bradley A. Gross, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Brian T. Jankowitz, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.).
Tudor G. Jovin, From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), University of Pittsburgh Medical Center, PA; Baptist Neurological Institute, Jacksonville, FL (A.A.); and Barrow Neurological Institute, Phoenix, AZ (A.F.D.). jovitg@upmc.edu.

Document Type

Article

Abstract

BACKGROUND AND PURPOSE: In patients identified at referring facilities with acute ischemic stroke caused by a large vessel occlusion, bypassing the emergency department (ED) with direct transport to the neuroangiography suite may safely shorten reperfusion times. METHODS: We conducted a single-center retrospective review of consecutive patients transferred to our facility for consideration of endovascular therapy. Patients were identified as admitted directly to the neuroangiography suite (DAN), transferred to the ED before intra-arterial therapy (ED-IA), and transferred to the ED but did not receive IA therapy (ED-IV). RESULTS: A retrospective review of a prospectively maintained database of transfer patients between January 2013 and October 2016 with large vessel occlusions identified 108 ED-IV patients and 261 patients who underwent mechanical thrombectomy (DAN=111 patients and ED-IA=150 patients). There were no differences in baseline characteristics among the 3 groups. The median computed tomography ASPECTS (Alberta Stroke Program Early CT Score) was lower in the ED-IV group versus the ED-IA and DAN groups (8 versus 9; =0.001). In the DAN versus ED-IA cohort, there were comparable rates of TICI2b/3 recanalization and access to recanalization time. There was significantly faster hospital arrival to groin access time in the DAN cohort (81 minutes versus 22 minutes; =0.001). Functional independence at 90 days was comparable in the DAN versus ED-IA cohorts but worse in the ED-IV group (43% versus 44% versus 22%; =0.001). CONCLUSIONS: DAN is safe, feasible, and associated with faster times of hospital arrival to recanalization. The clinical benefit of this approach should be assessed in a prospective randomized trial.

Keywords

emergency medicine, reperfusion, stroke, triage, workflow

Medical Subject Headings

Aftercare; Aged; Brain Ischemia (mortality, therapy); Cerebral Angiography (statistics & numerical data); Emergency Service, Hospital (statistics & numerical data); Endovascular Procedures (statistics & numerical data); Humans; Mechanical Thrombolysis (statistics & numerical data); Middle Aged; Outcome and Process Assessment, Health Care (statistics & numerical data); Patient Admission (statistics & numerical data); Patient Transfer (statistics & numerical data); Retrospective Studies; Stroke (mortality, therapy); Time Factors; Triage (statistics & numerical data)

Publication Date

7-1-2017

Publication Title

Stroke

E-ISSN

1524-4628

Volume

48

Issue

7

First Page

1884

Last Page

1889

PubMed ID

28536177

Digital Object Identifier (DOI)

10.1161/STROKEAHA.117.016946

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