Thrombectomy after in-house stroke in the transfer population

Area of Science:

• Neurology
• Vascular Neurology
• Health Services Research

Background:

• Patients with large-vessel occlusion (LVO) strokes presenting to non-thrombectomy-capable (spoke) hospitals have worse outcomes than those directly admitted to thrombectomy-capable (hub) centers.
• In-hospital strokes (IHS) are associated with worse outcomes compared to community-acquired strokes.
• Limited data exists on the outcomes of patients experiencing IHS at spoke hospitals.

Purpose of the Study:

• To characterize the population of patients experiencing IHS at spoke hospitals.
• To define the outcomes for this vulnerable patient group.
• To compare outcomes of IHS at spoke hospitals versus hub hospitals.

Main Methods:

• Retrospective review of prospectively collected data.
• Inclusion of patients with IHS at a spoke hospital transferred to a hub for endovascular therapy (EVT).
• Comparison of outcomes between patients with IHS at spoke versus hub hospitals.

Main Results:

• 108 IHS patients met criteria; 91 (84%) at spoke, 17 (16%) at hub.
• Significantly shorter times to IV-tPA (17 vs. 70 min) and EVT (120 vs. 247 min) in the hub group.
• Higher rates of favorable 90-day outcomes (mRS 0-3) in the hub group (57% vs. 22%).

Conclusions:

• Patients with IHS treated with EVT at spoke hospitals have significantly worse outcomes than those treated at hub hospitals.
• Prolonged delays in initiating IV-tPA and EVT are critical areas for improvement.
• Optimizing stroke care pathways for IHS patients at spoke hospitals is crucial.