Endovascular thrombectomy (EVT) is standard therapy for patients with acute stroke who meet strict criteria. Due to the fact that therapy can only be provided at highly specialized centers, many patients are transferred for treatment from distant hospitals.  The aim of this analysis was to determine whether patients who are transferred have the same rates of successful recanalization and clinical outcome as patients who present directly to tertiary centers. 

A retrospective chart review was conducted on all patients undergoing EVT from 2015-2018 at a comprehensive stroke center (CSC), comparing outcomes between transfer patients and those presenting directly to the stroke center. Groups were compared on NIHSS, time to recanalization, TICI score (successful recanalization defined as TICI 2B or greater) and 90 day mRS (good outcome mRS ≤ 2). Data analysis was completed with IBM SPSS 25. 

Our sample included 229 patients: 29% initially presented to the CSC and 71% were transferred from another facility. Mean age did not differ between groups (63.7 vs. 65.1 (p=0.788)), but transferred patients had more severe strokes (mean NIHSS 18.1 vs. 16.8, P=0.004), longer times from LKN to recanalization (mean 421.8 vs. 380.9 minutes, median 354.5 vs 320 minutes) and were more likely to be treated with IV tPA (56% vs. 30%; p=0.002). The proportion of patients with a good 90-day outcome was similar between groups (44% vs. 40%; p=0.658).

The results of this study suggest that patients who are transferred with acceptable ASPECTs score do as well as patients who present directly to the tertiary center. As such, we should continue to offer transfer for EVT to patients presenting to outside hospitals.