Abstract
Introduction: For patients with large vessel occlusion (LVO) stroke, time to treatment with endovascular thrombectomy (EVT) is crucial to prevent irreversible infarction and improve outcomes. We sought to evaluate the arrival-to-puncture times and outcomes for LVO patients transferred directly to the angio-suite (LVO2OR) versus those accepted through the emergency department (ED). Methods: Consecutive patients transferred for EVT within a hub-and-spoke model with spoke CTA-confirmed LVO, spoke ASPECTS >6, and last known well-to-hub arrival <6 hours were identified from a prospectively maintained database. The LVO2OR protocol began implementation in January 2017. The LVO2OR cohort includes patients who underwent EVT from July 2017 to October 2020, and the ED cohort includes those from January 2011 to December 2016. Arrival-to-puncture time and 90-day modified Rankin Scale (mRS) were prospectively recorded. Results: The LVO2OR cohort was comprised of 91 patients and the ED cohort 90 patients. LVO2OR patients had more atrial fibrillation (AF, 51% vs 32%, p=0.02) and more M2 occlusions (27% vs 10%, p=0.01), but otherwise similar demographics, medical history, and presentations. They had dramatically faster median hub arrival-to-puncture times (11 vs 92 min, p<0.001), more TICI 2b-3 (92% vs 69%, p<0.001), and more 90-day mRS 0-1 (35% vs 21%, p=0.04). In a multivariable model, LVO2OR significantly increased the odds of 90-day mRS 0-1 (aOR 2.77, 95%CI 1.07,7.20; p=0.04) even when controlling for age, baseline mRS, AF, NIHSS, M2 location, and TICI 2b-3. Conclusion: Within a hub-and-spoke Telestroke network, transferring eligible LVO patients directly to the angio-suite was associated with dramatically reduced arrival-to-puncture times and improved 90-day outcomes. Direct to angio-suite systems of care should be considered in Telestroke networks to expedite high-quality stroke care.
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