Rurality and Outcomes of Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke

Objective: To investigate differences in outcomes among patients with acute ischemic stroke from large vessel occlusion (AIS-LVO) transferred from rural and urban hospitals to University of Maryland Medical Center (UMMC) for mechanical thrombectomy (MT). Methods: We identified patients with AIS-LVO transferred to UMMC for MT from July 2016 to June 2023. Primary outcome was good neurologic outcome, defined as 90-day modified Rankin score 0-2. Multivariable logistic regression was used to identify predictors for the primary outcome. Results: We analyzed 526 patients, 233 (44%) transferred from rural hospitals in Maryland. Median NIHSS was 17 [IQR 14-20] and was similar between groups. Patients from state-designated rural hospitals were transferred from a longer distance (difference of 57.8 km, p=0.001), but had shorter intervals from last known well time to recanalization (difference 19 min, p=0.24). They had similar odds of good neurologic outcome (OR 0.88, 95% CI 0.43-1.78, p=0.72). Conclusions: Patients transferred from rural areas for MT for AIS-LVO, at our institution, had a similar likelihood of achieving 90-day mRS 0-2 as those transferred from urban areas.