Interfacility Transfer for Thrombectomy: A Promising Therapeutic Window

Area of Science:

• Neurology
• Interventional Neuroradiology
• Emergency Medicine

Background:

• Most acute ischemic stroke patients with large vessel occlusion are initially treated at non-thrombectomy-capable centers.
• Interfacility transfer to thrombectomy-capable centers is often delayed due to complex coordination, negatively impacting clinical outcomes.

Purpose of the Study:

• To review clinical and radiological changes during interfacility transfer for thrombectomy.
• To explore therapeutic strategies for reducing infarct growth during transfer.
• To discuss trial design considerations for optimizing care during this critical period.

Main Methods:

• Literature review summarizing clinical and radiological changes.
• Analysis of infarct growth, collateral changes, recanalization, and hemorrhagic transformation.
• Discussion of therapeutic interventions and clinical trial methodologies.

Main Results:

• Clinical and radiological changes during transfer are heterogeneous among patients.
• These changes significantly impact long-term functional outcomes.
• Evidence suggests potential benefits from strategies like penumbral protection.

Conclusions:

• Optimizing care during interfacility transfer is urgently needed.
• Further research and clinical trials are essential to reduce infarct growth and improve outcomes for stroke patients.
• Understanding transfer-related changes is key to developing effective interventions.