Direct transfer to angiosuite vs conventional workup for stroke: A systematic review and meta-analysis

Area of Science:

• Neurology
• Interventional Radiology
• Public Health

Background:

• Reducing time to treatment in stroke patients undergoing thrombectomy is crucial for functional recovery.
• Large vessel occlusion (LVO) stroke requires rapid endovascular intervention.
• Comparing direct transfer to angiosuite (DTAS) with conventional workup (CWU) is essential for optimizing stroke care pathways.

Purpose of the Study:

• To compare the effectiveness and safety of DTAS versus CWU in patients with LVO stroke undergoing endovascular treatment.
• To evaluate the impact of DTAS on functional outcomes, reperfusion rates, and treatment times.
• To assess the feasibility, safety, and cost-effectiveness of the DTAS approach.

Main Methods:

• A systematic literature search was conducted across four electronic databases.
• Continuous outcomes were analyzed using standardized mean difference (SMD) with 95% confidence intervals (CI).
• Binary outcomes were analyzed using odds ratios (OR) with 95% CI.

Main Results:

• DTAS was associated with significantly higher rates of 90-day functional independence (mRS 0-1 and 0-2) and successful reperfusion compared to CWU.
• DTAS significantly reduced door-to-puncture times.
• No significant differences were observed in 90-day mortality or symptomatic intracranial hemorrhage between the groups.
• The proportion of patients misdiagnosed with LVO and triaged to DTAS was 5.76%.

Conclusions:

• Direct transfer to angiosuite (DTAS) is a feasible, safe, and effective triage strategy for acute LVO stroke.
• DTAS improves functional outcomes and reduces treatment times in stroke patients.
• This approach represents a potentially cost-effective method for managing LVO stroke.