Abstract TMP10: Real-World Analysis of Endovascular Stroke Therapy Outcomes for Patients With Large Vessel Occlusions After Inter-Hospital Transfer

Abstract

Introduction: Prior studies suggest that patients with large vessel occlusion (LVO) who undergo endovascular stroke therapy (EST) after inter-hospital transfer (IHT) have worse outcomes than those who present directly to EST centers. However, these studies were largely derived from clinical trials or registries and may not be representative of real-world clinical practice. Methods: We performed a multicenter, observational cohort study on acute ischemic stroke (AIS) patients with LVO that presented to EST-capable centers directly (LVO-D) or after IHT (LVO-T) between 1/1/2018 to 2/1/2019. The study included 11 hospitals in the Houston area, of which 4 are EST-capable. Clinical data were collected using our cerebrovascular data registry. All transfers were from non-EST capable hospitals to EST-capable hospitals. Logistic regression adjusted for age, NIHSS, occlusion location and direct vs transfer arrival was used to assess the likelihood of good outcome, defined as discharge to home or rehabilitation. Results are given as median [IQR] and OR [95% CI]. Results: Among 4,313 patients with AIS, 772 (18%) patients had LVO. Among LVO patients, median age was 68 [59-79], 47% were female, 51% were white, 378 (49%) were LVO-D and 394 (51%) were LVO-T. Median IHT time was 152 min [114-198]. LVO-D patients arrived at EST-treating hospitals with superior ASPECTS compared to LVO-T (9 [7-10] vs 7 [6-9], p<0.0001), but comparable CTP RAPID infarct cores (5 mL [0-31] vs 7 mL [0-38], p=0.59). LVO-D and LVO-T patients were just as likely to have ICA occlusions (13% vs 12%; p=.64) and proceeded to have equivalent rates of EST (43% vs 47%, p=0.95). Among LVO patients who did not receive EST, good discharge outcomes were comparable (34% vs. 35%, p=0.66, LVO-D vs. LVO-T). Good discharge outcomes were also similar for those receiving EST (34% vs. 37%, p=0.57, LVO-D vs. LVO-T). In logistic regression adjusted for age, NIHSS, and occlusion location, likelihood of good discharge outcome was comparable between the two groups (OR 0.98 [0.71-1.36]). Conclusion: In this real-world cohort of a multi-center stroke network, IHT was not associated with worse outcomes for patients with LVO, for both patients who did receive EST and those that did not.