Abstract
Background: It is unknown if repeat imaging of transfer patients for endovascular thrombectomy (EVT) results in better patient selection and improved clinical outcomes or if bypassing repeat imaging and direct transfer to the angiosuite is safe, saves time and improve outcomes. Methods: A multicenter retrospective cohort was pooled from 6 centers (Europe and US) from 1/2014 to 4/2018 of patients with anterior circulation occlusion (ICA, M1, M2) transferred for EVT up to 24 hours from last known well. Patients were divided based on imaging acquisition at the EVT center into those who underwent any repeat imaging (CT+/- CTA, CTP) and those who bypassed imaging and went directly to the angiosuite. We compared good outcome (90 day mRS 0-2) and safety (sICH, mortality) between the two groups. Results: Of 646 patients, 559 received EVT and 87 were excluded for poor imaging profiles. In patients who received EVT, 173 (31%) had no repeat nd 386 (69%) had repeat images. The two groups had similar age and NIHSS. ASPECTS was lower in the repeat images group 8(7-10) when compared to ASPECTS from the outside facility in the non-repeat 9(8-10), p<0.001. Repeat imaging prolonged arrival to puncture times 65(41-98) in the repeat vs 23(14-62) min for non-repeat group, P<0.001 without correlating with better rates of good outcome (42% repeat vs 51% no repeat (Fig 1), aOR 0.75 (0.39-1.47), p=0.41) and similar safety: sICH (9% vs 6%, p=0.29) and mortality (20% vs 16%, p=0.35). The results did not vary when stratified by early (0-6 hrs) vs late (6-24 hrs) treatment. Matching patients who did not receive EVT due to low ASPECTS with those who underwent EVT with low ASPECTS showed no increase in sICH (0% vs 4%, p=1.0) and better rates of mRS 0-2 with EVT (33%) vs medical management only (7%), p=0.15. Conclusion: In patients transferred for EVT, repeat imaging resulted in treatment delays without improving good outcome. Direct angio suite access may result in more patients treated safely who achieve good outcome.
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