Arterial Recanalization During Interhospital Transfer for Thrombectomy

Area of Science:

• Neurology
• Interventional Neuroradiology
• Vascular Medicine

Background:

• Patients with acute ischemic stroke and large vessel occlusion often require transfer for endovascular thrombectomy.
• Interhospital transfer presents challenges, with potential for arterial recanalization during transit.

Purpose of the Study:

• Evaluate the incidence and predictors of arterial recanalization during interhospital transfer.
• Assess the relationship between interhospital recanalization and clinical outcomes in acute ischemic stroke patients.

Main Methods:

• Analysis of two cohorts (Montpellier, France; Stanford, USA) of anterior circulation large vessel occlusion patients transferred for thrombectomy.
• Comparison of arterial imaging before and after transfer to determine interhospital recanalization (revised arterial occlusive lesion [rAOL] score 2b-3).
• Multivariable logistic regression to identify pretransfer variables associated with recanalization.

Main Results:

• Twenty-one percent (111/520) of patients achieved interhospital recanalization (77% partial, 23% complete).
• Independent predictors of recanalization included intravenous thrombolysis, more distal occlusions, and smaller clot burden.
• Recanalization correlated with reduced infarct growth and improved National Institutes of Health Stroke Scale scores during transfer.
• Interhospital recanalization was associated with significantly reduced 3-month disability, with greater benefit from complete recanalization.

Conclusions:

• Arterial recanalization during interhospital transfer for acute ischemic stroke is frequent and associated with favorable outcomes.
• Broadening thrombolysis indications and developing therapies to enhance transfer recanalization may improve clinical results.