Direct admission vs. secondary transfer for mechanical thrombectomy: long-term clinical outcomes from a single Polish Comprehensive Stroke Centre
, 1, 1, 2, 2, 3, 1
Abstract
Introduction: We aimed to compare 3-month clinical outcomes after mechanical thrombectomy (MT) in patients transferred directly to a comprehensive stroke centre (‘mothership’, MS) to the outcomes of patients transferred secondarily from primary stroke centres (‘drip-and-ship’, DAS) in Lubelskie province, the third largest province in Poland. Material and methods: In a prospective stroke registry, all patients with large vessel occlusion in anterior circulation admitted within six hours of onset and treated with MT between 2017 and 2020 were retrospectively analysed. Results: A total of 400 patients was evaluated: 267 treated with the MS approach and 133 with the DAS approach. Time from stroke onset to groin puncture was shorter in the MS group. There was a significant difference in 3-month excellent clinical outcomes (mRS 0–1) between these two groups (32.9% of MS patients vs. 22.5% of DAS patients, p < 0.05), but there was no difference if the 3-month endpoint was expressed as mRS ≤ 2 (42.3% of MS vs. 34.5% of DAS patients, p = 0.13). The rate of symptomatic intracranial haemorrhage and mortality was comparable in both groups. Conclusions: Our study shows that direct admission to a comprehensive stroke centre resulted in more patients achieving excellent treatment outcomes (mRS 0–1). At the same time, the superiority of the MT model over the DAS model in obtaining mRS 0–2 was not unequivocally demonstrated. Further studies are needed to determine the best stroke model for patients potentially eligible for MT.
Keywords: mothershipdrip and shipacute ischaemic strokemechanical thrombectomyregional stroke care
References
- Ismail M, Armoiry X, Tau N, et al. Mothership versus drip and ship for thrombectomy in patients who had an acute stroke: a systematic review and meta-analysis. J Neurointerv Surg. 2019; 11(1): 14–19.
- Ribo M (2020) RACECAT results presented at ESO-WSO 2020. https://eso-wso-conference.org/wp-content/uploads/sites/42/2020/11/News-from-ESO-WSO-2020-Conference-PR1_Eng.pdf (April 3 2021).
- Romoli M, Paciaroni M, Tsivgoulis G, et al. Mothership versus drip-and-ship model for mechanical thrombectomy in acute stroke: A systematic review and meta-analysis for clinical and radiological outcomes. J Stroke. 2020; 22(3): 317–323.
- Schlemm L, Endres M, Nolte CH. Bypassing the closest stroke center for thrombectomy candidates: what additional delay to thrombolysis is acceptable? Stroke. 2020; 51(3): 867–875.
- Błażejewska-Hyżorek B, Czernuszenko A, Członkowska A, et al. Ischemic stroke guidelines. Polski Przegląd Neurologiczny. 2019; 15: 53–55.
- Larrue V, von Kummer R R, Müller A, et al. Risk factors for severe hemorrhagic transformation in ischemic stroke patients treated with recombinant tissue plasminogen activator: a secondary analysis of the European-Australasian Acute Stroke Study (ECASS II). Stroke. 2001; 32(2): 438–441.
- Khatri P, Yeatts SD, Mazighi M, et al. IMS III Trialists. Time to angiographic reperfusion and clinical outcome after acute ischaemic stroke: an analysis of data from the Interventional Management of Stroke (IMS III) phase 3 trial. Lancet Neurol. 2014; 13(6): 567–574.
- Fransen PSS, Berkhemer OA, Lingsma HF, et al. Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands Investigators. Time to reperfusion and treatment effect for acute ischemic stroke: A randomized clinical trial. JAMA Neurol. 2016; 73(2): 190–196.
- Ota T, Nishiyama Y, Koizumi S, et al. Impact of onset-to-groin puncture time within three hours on functional outcomes in mechanical thrombectomy for acute large-vessel occlusion. Interv Neuroradiol. 2018; 24(2): 162–167.
- Coutinho JM, Liebeskind DS, Slater LA, et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: A pooled analysis of the SWIFT and STAR studies. JAMA Neurol. 2017; 74(3): 268–274.
- Fischer U, Kaesmacher J, Mendes Pereira V, et al. Direct mechanical thrombectomy versus combined intravenous and mechanical thrombectomy in large-artery anterior circulation stroke: A topical review. Stroke. 2017; 48(10): 2912–2918.
- Rinaldo L, Brinjikji W, McCutcheon BA, et al. Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke. J Neurointerv Surg. 2017; 9(12): 1166–1172.
- Weisenburger-Lile D, Blanc R, Kyheng M, et al. on behalf of the Endovascular Treatment in Ischemic Stroke Investigators. 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. 2019; 47(3-4): 112–120.
- Gerschenfeld G, Muresan IP, Blanc R, et al. Two paradigms for endovascular thrombectomy after intravenous thrombolysis for acute ischemic stroke. JAMA Neurol. 2017; 74(5): 549–556.
