Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke

J Neurointerv Surg. 2017 Dec;9(12):1166-1172. doi: 10.1136/neurintsurg-2016-012824. Epub 2016 Dec 16.

Abstract

Background: Patients with an acute ischemic stroke (AIS) due to large vessel occlusion often require transfer to an endovascular center for treatment.

Objective: To assess the effect of hospital transfer on outcomes after endovascular revascularization.

Methods: Outcomes of endovascular revascularization were compared between directly admitted and transferred patients using data from a national database and our own institution.

Results: 118 institutions within the database reported outcomes of 8533 inpatient admissions for endovascular treatment of AIS. Mortality rate (14.9% vs 18.6%; p=0.049) and mortality index (1.1 vs 1.6; p=0.048) were significantly lower among directly admitted patients than among transferred patients. Within our institutional cohort of 140 patients who underwent endovascular therapy, directly admitted patients had a significantly faster time to revascularization than transferred patients (277.4 vs 420.4 min; p≤0.0001). Among transferred patients, an increasing distance of transferred hospital to our home institution was associated with an increasing risk of mortality (unit OR=1.26, 95% CI 1.07 to 1.54; p=0.0061).

Conclusions: Outcomes of revascularization may improve with methods to identify patients with large vessel occlusion before hospital admission, thus increasing the likelihood of initial triage to a comprehensive stroke center for patients eligible for endovascular intervention.

Keywords: Embolic; Intervention; Stroke.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / mortality*
  • Brain Ischemia / surgery*
  • Cohort Studies
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / mortality*
  • Endovascular Procedures / trends
  • Female
  • Hospitalization / trends
  • Humans
  • Middle Aged
  • Patient Transfer* / trends
  • Stroke / mortality*
  • Stroke / surgery*
  • Thrombectomy
  • Treatment Outcome
  • Triage / trends