Medium vessel occlusions in the drip-and-ship model: Clinical vs. hub CTP-supported decision making

Mechanical thrombectomy (MT) for medium vessel occlusions (MeVO) is emerging as a promising treatment in acute stroke. We aim to evaluate the utility of additional imaging (CTP) in patients with MeVOs who received thrombolysis at a spoke hospital and were transferred to the hub.

This was a retrospective review of prospectively collected data from April 2018 to June 2023. Patients were transferred to one of the following destinations: CT scanner for a perfusion scan, directly to the angiography suite, or admitted to the neurological intensive care unit (NICU). We compared baseline characteristics, MT times, radiographic and clinical outcomes between the group that was initially transferred to CTP vs. the group that was not initially transferred to CTP.

Seventy-eight MeVO patients who received IV thrombolysis and were transferred to our comprehensive stroke center were included in the analysis. Forty patients went directly to CTP, thirty went directly to the angiography suite (DTA), and eight were transferred to the NICU. 67.5% of patients presenting to CTP did not subsequently go to the angiography suite. The CTP and non-CTP groups did not differ significantly in terms of demographics, rates of successful recanalization, complications, and clinical outcomes at 90 days. The CTP group had significantly longer median door-to-groin times and median door-to-recanalization times.

Mechanical thrombectomy should be considered in stroke patients with confirmed medium vessel occlusions who receive thrombolysis. CTP utilization may lead to lower angiography utilization and longer door-to-procedure times but does not significantly affect long-term outcomes.