Abstract Details

Title Does Transfer Status Affect Outcomes in Acute Ischemic Stroke Patients Treated Endovascularly?

Topic Interventional Neurology

Presentation(s) S46 - (-)

Poster/Presentation
Number 003

Objective

Background Access to intra-arterial therapy (IAT) for acute ischemic stroke (AIS) is limited to comprehensive stroke centers (CSCs) with timely access deemed critical for success. Inter-hospital transfers represent a growing subset of patients in which outcomes have not been well-studied.

Design/Methods We retrospectively analyzed consecutive anterior circulation AIS patients that underwent IAT at 4 institutions from 2006-2011. We excluded patients selected using perfusion imaging. Patient demographics, medical risk factors, presentations, technical, and clinical (NIHSS and mRS scores) outcomes, complications, and mortality were studied. Symptom-onset, groin puncture, and end-of-procedure times were recorded. THRIVE scores were calculated. Successful recanalization was defined as TICI?2b. Good functional outcome was defined as mRS 0-2 at 90 days. Patients were categorized into those who were transferred from outside institutions and those who presented directly to the CSCs.

Results 116 patients were studied. 68 (58.6%) were transferred from outside institutions. Transfers and non-transfers were similar in THRIVE scores (p=0.300), median symptom-onset to groin puncture times (306 vs. 315 minutes; p=0.572), successful recanalization (p=0.574), and symptomatic ICH (13.2 vs. 10.4, p=0.776), but differed by age (59 vs. 69 years;p=0.002), prior stroke (3% vs. 22%,p=0.002), cardiac history (17.9 vs. 36.6%,p=0.040), baseline NIHSS (20 vs. 17, p=0.005), and location of occlusion (45.6% vs. 22.9% ICA, p=0.012). Transfer patients had significantly worse outcomes at 90 days (mRS 0-2: 16.2% vs. 60.4%,p<0.001). In multivariate analysis, transfer status was an independent predictor of poor functional outcome (adj. OR 0.05, 0.011-0.222), adjusting for relevant covariates.

Conclusions Transferred AIS patients have worse functional outcomes at 90 days than non-transfers, independent of baseline risk factors, stroke severity, time to IAT, and procedural success/complications. Further investigation should focus on residual factors that may contribute to our findings such as baseline/final infarct volumes, pre-morbid functional status, and post-stroke care.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
James Conners, MD (Rush University Medical Center)	The institution of Dr. Conners has received research support from nih.
Vivien H. Lee, MD, FAAN (OSU Comprehensive Neurovascular Center)	Dr. Lee has nothing to disclose.
Richard A. Bernstein, MD (Northwestern University)	No disclosure on file
	No disclosure on file
	No disclosure on file
Reinhard Hiersemenzel, MD (Merz Pharmaceuticals GmbH)	No disclosure on file
	No disclosure on file
Sameer Ansari	No disclosure on file
Shyam Prabhakaran, MD (University of Chicago)	Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. Dr. Prabhakaran has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for University of Cincinnati. The institution of Dr. Prabhakaran has received research support from NIH . The institution of Dr. Prabhakaran has received research support from AHRQ. Dr. Prabhakaran has received publishing royalties from a publication relating to health care.

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