Abstract Details

Title Impact of Direct Transportation to a Thrombectomy Center vs Closest Primary Stroke Center on Treatment Times Among Non-Urban Patients Undergoing Mechanical Thrombectomy in a Large Healthcare System

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-005

Objective To study the impact of direct transfer to a Thrombectomy Capable Center (TC) vs transfer to a Primary Stroke Center (PSC) on Acute Ischemic Stroke (AIS) Treatment times among non-urban patients with Large Vessel occlusion (LVO) undergoing Mechanical Thrombectomy (MT) in our healthcare system.

Background Our statewide Emergency Medical Services (EMS) protocols recommend that patients with a suspicion of an LVO may bypass the closest Stroke center to be transferred to a TC if it can be reached within 45 minutes.

Design/Methods This is a retrospective analysis of a prospectively maintained database of AIS patients between January 2021 and October 2023. We included consecutive patients with LVO who presented with pre-arrival notifications via EMS either directly to one of our two TC or were transferred from one of 11 PSC within our telestroke network to a TC and underwent MT. Patients who presented directly to TC and were within 30 minutes of driving distance were excluded. This cohort was divided into two groups: patients presenting directly to TC (DTC) and those initially transported to closest Stroke center (DSC). Primary outcomes were First Medical contact to Arterial Puncture time (FMC-to-AP) and First Medical Contact to Intravenous thrombolysis time (FMC-to-IVT). The Mann-Whitney U test was used to assess significant differences in continuous variables between the two groups.

Results Among 225 patients analyzed, 111(49.3%) were DTC. Median age was 72 years [IQR 62.0 - 81.0], median baseline NIHSS was 17 [IQR 12.0 - 22.0]. DTC patients had shorter FMC-to-AP (118min [IQR 106–138] vs. 200min [166–274], p<0.001), and similar FMC-to-IVT (83.0min [69–89.8] vs 87min [75–115], p=0.09).

Conclusions Among non-urban patients with LVO, direct transport to TC was associated with shorter FMC-to-AP without impacting FMC-to-IVT. Further research should focus on investigating the impact of these transport strategies on AIS treatment times across healthcare systems.

Authors/Disclosures
Abdullah M. Al-Qudah, MD (University of Pittsburgh Medical Center) PRESENTER	Dr. Al-Qudah has nothing to disclose.
Christian Martin-Gill, MD	The institution of Dr. Martin-Gill has received research support from Pittsburgh Emergency Medicine Foundation. The institution of Dr. Martin-Gill has received research support from Department of Defense / US Army. The institution of Dr. Martin-Gill has received research support from National Institute of Health. The institution of Dr. Martin-Gill has received research support from Defense Advanced Research Projects Agency (DARPA). The institution of Dr. Martin-Gill has received research support from American Academy of Sleep Medicine (AASM) . The institution of Dr. Martin-Gill has received research support from Pediatric Pandemic Network (PPN) . The institution of Dr. Martin-Gill has received research support from American College of Medical Toxicology (ACMT).
Katharine Dermigny, MD (Dr Dermingy)	Dr. Dermigny has nothing to disclose.
Mohamed Fahmy Doheim (University of Pittsburgh)	Mr. Doheim has nothing to disclose.
Lucas Rios Rocha, MD (UPMC)	Dr. Rios Rocha has nothing to disclose.
Abdullah Sultany, MD	Dr. Sultany has nothing to disclose.
Marcelo Rocha, MD, PhD (UPMC)	The institution of Dr. Rocha has received research support from NIH.
Matthew T. Starr, MD (University of Pittsburgh Medical Center)	Dr. Starr has nothing to disclose.
Jussie Correia Lima, MD	Dr. Correia Lima has nothing to disclose.
Alhamza Al-Bayati, MD (UPMC Stroke Institute)	Dr. Al-Bayati has nothing to disclose.
Francis X. Guyette, MD	The institution of Dr. Guyette has received research support from DoD.
Raul G. Nogueira, MD (UPMC Stroke Institute)	Dr. Nogueira has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron (consulting fees) as well as for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze ( stock options). Dr. Nogueira has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firms. Dr. Nogueira has received stock or an ownership interest from Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, and Viseon. The institution of Dr. Nogueira has received research support from Cerenovus.
Nirav Bhatt, MD (University of Pittsburgh)	Dr. Bhatt has nothing to disclose.

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