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2016 ; 9
(2
): 79-84
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Outcome and periprocedural time management in referred versus directly admitted
stroke patients treated with thrombectomy
#MMPMID27006695
Weber R
; Reimann G
; Weimar C
; Winkler A
; Berger K
; Nordmeyer H
; Hadisurya J
; Brassel F
; Kitzrow M
; Krogias C
; Weber W
; Busch EW
; Eyding J
Ther Adv Neurol Disord
2016[Mar]; 9
(2
): 79-84
PMID27006695
show ga
BACKGROUND: After thrombectomy has shown to be effective in acute stroke patients
with large vessel occlusion, the potential benefit of secondary referral for such
an intervention needs to be validated. AIMS: We aimed to compare consecutive
stoke patients directly admitted and treated with thrombectomy at a
neurointerventional centre with patients secondarily referred for such a
procedure from hospitals with a stroke unit. METHODS: Periprocedure times and
mortality in 300 patients primarily treated in eight neurointerventional centres
were compared with 343 patients referred from nine other hospitals in a
prospective multicentre study of a German neurovascular network. Data on
functional outcome at 3 months was available in 430 (76.4%) patients. RESULTS:
In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality
(21.9% versus 24.1%, p = 0.53) were not statistically different in both patient
groups despite a significant shorter symptom to groin puncture time in directly
admitted patients, which was mainly caused by a longer interfacility transfer
time. We found a nonsignificant trend for better functional outcome at 3 months
in directly admitted patients (modified Rankin Scale 0-2, 44.0% versus 35.7%, p =
0.08). CONCLUSIONS: Our results show that a drip-and-ship thrombectomy concept
can be effectively organized in a metropolitan stroke network. Every effort
should be made to speed up the emergency interfacility transfer to a
neurointerventional centre in stroke patients eligible for thrombectomy after
initial brain imaging.