Direct Admission vs. Secondary Transfer to aComprehensive Stroke Center for Thrombectomy : Retrospective Analysis of aRegional Stroke Registry with 2797 Patients.

Abstract

This study aimed at comparing short-term clinical outcome after thrombectomy in patients directly admitted (DA) to acomprehensive stroke center with patients secondarily transferred (ST) from aprimary stroke center. In aprospective regional stroke registry, all stroke patients with a premorbid modified Rankin scale (mRS) score 0-2 who were admitted within 24 h after stroke onset and treated with thrombectomy between 2014 and 2017 were retrospectively analyzed. Patients with DA and ST were compared regarding the proportion of good outcome (discharge mRS0-2), median discharge mRS, mRS shift (difference between premorbid mRS and mRS on discharge) and occurrence of symptomatic intracranial hemorrhage. Out of 2797 patients, 1051 (37.6%) achieved good clinical outcome. In the DA group (n = 1657), proportion of good outcome was higher (DA 42.2% vs. ST 30.9%, P < 0.001) and median discharge mRS (DA3 vs. ST4, P < 0.001) and median mRS shift (DA3 vs. ST4, P < 0.001) were lower. The rate of symptomatic intracranial hemorrhage was similar in both groups (DA9.3% vs. ST7.5%, P = 0.101). Multivariate analysis revealed that direct admission was an independent predictor of good clinical outcome (adjusted odds ratio, OR 1.32, confidence interval, CI 1.09-1.60, P = 0.004). These results confirm prior studies stating that DA to acomprehensive stroke center leads to better outcome compared to ST in stroke patients undergoing thrombectomy.