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Updated: Feb 27, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Immediate Vascular Imaging Needed for Efficient Triage of Patients With Acute Ischemic Stroke Initially Admitted to
Gregoire Boulouis1, Khawja-Ahmeruddin Siddiqui1, Arne Lauer1
1From the Stroke Research Center, Boston, MA (G.B., A.L., A.C., A.V., N.R., L.H.S.); Stroke Service, Boston, MA (K.-A.S. R.W.R., A.V., T.M.L.-M., N.R., L.H.S.); Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston (R.W.R., T.M.L.-M.); and Neuroradiology Department, CH Sainte-Anne, Université Paris-Descartes, INSERM U894, France (G.B.).
Insights
Implementing baseline vascular imaging can significantly reduce unnecessary patient transfers for endovascular thrombectomy (EVT). This approach optimizes selection criteria for stroke care, improving efficiency and patient outcomes.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Current guidelines for endovascular thrombectomy (EVT) patient selection may lead to unnecessary transfers to specialized stroke centers.
- Evaluating the impact of baseline vascular imaging on transfer decisions is crucial for optimizing stroke care pathways.
Purpose of the Study:
- To assess the effect of simulated baseline vascular imaging on reducing unnecessary patient transfers for EVT.
- To identify clinical and imaging factors associated with successful EVT after inter-facility transfer.
Main Methods:
- Retrospective analysis of 508 patients transferred for EVT between 2010 and 2016.
- Assessed initial CT scans (Alberta Stroke Program Early CT Score) and vascular occlusion at the receiving center.
- Simulated triaging models using current guidelines versus enhanced criteria including baseline vascular imaging.
Main Results:
- Current EVT guidelines showed 92% sensitivity and 53% specificity for selecting patients who received EVT.
- Simulated optimal criteria (NIH Stroke Scale >8 plus baseline vascular imaging) improved specificity to 80% while maintaining 91% sensitivity.
- This suggests a significant reduction in futile transfers is achievable.
Conclusions:
- Implementing baseline vascular imaging at referring hospitals can substantially decrease unnecessary transfers for EVT.
- A data-driven framework incorporating vascular imaging can inform and improve inter-facility transfer policies for stroke patients.
Background And Purpose:
Current guidelines for endovascular thrombectomy (EVT) used to select patients for transfer to thrombectomy-capable stroke centers (TSC) may result in unnecessary transfers. We sought to determine the impact of simulated baseline vascular imaging on reducing unnecessary transfers and clinical-imaging factors associated with receiving EVT after transfer.
Methods:
We identified patients with stroke transferred for EVT from 30 referring hospitals between 2010 and 2016 who had a referring hospitals brain computed tomography and repeat imaging on TSC arrival available for review. Initial Alberta Stroke Program Early CT scores and TSC vascular occlusion level were assessed. The main outcome variable was receiving EVT at TSC. Models were simulated to derive optimal triaging parameters for EVT.
Results:
A total of 508 patients were included in the analysis (mean age, 69±14 years; 42% women). Application at referring hospitals of current guidelines for EVT yielded sensitivity of 92% (95% confidence interval, 0.84-0.96) and specificity of 53% (95% confidence interval, 0.48-0.57) for receiving EVT at TSC. Repeated simulations identified optimal selection criteria for transfer as National Institute of Health Stroke Scale >8 plus baseline vascular imaging (sensitivity=91%; 95% confidence interval, 0.83-0.95; and specificity=80%; 95% confidence interval, 0.75-0.83).
Conclusions:
Our findings provide quantitative estimates of the claim that implementing vascular imaging at the referring hospitals would result in significantly fewer futile transfers for EVT and a data-driven framework to inform transfer policies.
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