Abstract TMP62: Safety and Efficacy of Endovascular Treatment in the “Hub and Spoke Model”

Abstract

Background: There are three different pathways for receiving endovascular treatment: primary ED arrival, in-patient, and outside transfer. Each mode has unique attributes that influence the performance and possibly the results of endovascular treatment in acute ischemic stroke patients. Objective: To compare the rates of various outcomes among patients who receive endovascular treatment through primary ED arrival, in-patient, and outside transfer modes. Methods: We performed a review of acute ischemic stroke patients presenting to our facility who received endovascular treatment from 2004 until 2012. Patient route (ER, inpatient, transfer), rates of poor outcome at discharge (modified Rankin score [mRS] of >3), intracerebral hemorrhages (ICH), as well as patients’ clinical characteristics were obtained and analyzed. Results: Among the total 336 patients that underwent IA thrombolysis, 68 patients (mean age 69.1± 16.6; 54% men) were transferred, while 38 patients (mean age 61.1± 14.5; 58% men) were in-patient strokes. Demographics, clinical characteristics, and outcomes are detailed below (Table 1 & 2). The mean admission NIHSS was significantly higher in the transferred patients (16.2± 9.5 versus 15.5± 6.2, p<0.001), though there was no difference in discharge NIHSS. After adjusting for all potential confounders there was no significant difference in good outcomes (odds ratio [OR] 2.0 95% Confidence interval [CI] 0.9-4.3, p=0.06), ICH (OR 0.6 95% CI 0.3-1.3, p=0.2), or mortality (OR 0.6 95% CI 0.3-1.4, p=0.2) between ER patients and transferred patients. Conclusions: Despite the increased baseline stroke severity, there appears to be no significant risk of increased poor outcomes, ICH, or mortality in acute ischemic stroke patients transferred to endovascular centers. This further justifies the safety and efficacy of the hub and spoke model.