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The Impact of the Bypass Transport Method on Clinical Outcomes After Large Vessel Occlusion: A Pooled-Proportion
Alexa R Lauinger1, Caleb Bowman1, Wedam Nyaaba1
1Carle Illinois College of Medicine, Urbana, IL, USA.
Insights
Direct transport to comprehensive stroke centers (CSCs) significantly speeds mechanical thrombectomy (MT) for large vessel occlusion strokes. While MT times improved, 90-day mortality and functional outcomes did not differ significantly between direct and bypass transport methods.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Ischemic strokes are a leading global cause of death.
- Mechanical thrombectomy (MT) is a critical treatment for large vessel occlusions.
- Optimal emergency transport strategies for stroke patients remain under investigation, particularly regarding direct transport to comprehensive stroke centers (CSCs).
Purpose of the Study:
- To compare clinical outcomes of direct transport versus bypass transport to a CSC for patients with suspected large vessel occlusion stroke.
- To evaluate the impact of transport strategy on time to treatment, 90-day mortality, and functional outcomes.
Main Methods:
- A comprehensive literature search was conducted across PubMed, Scopus, and Web of Science.
- A meta-regression analysis compared outcomes for patients directly transported to CSCs versus those transferred from peripheral stroke centers.
- Key outcome measures included time to treatment, 90-day mortality, and functional outcomes.
Main Results:
- The analysis included 260 articles.
- Direct transport to CSCs resulted in significantly faster times to MT (225.6 vs. 275.4 minutes; P=0.0114).
- No significant differences were observed in 90-day mortality or good neurological outcome rates between the two transport groups.
Conclusions:
- Direct transport to CSCs offers a significant advantage in reducing time to mechanical thrombectomy for large vessel occlusion strokes.
- Despite faster MT times, direct transport did not lead to statistically significant improvements in 90-day mortality or functional outcomes compared to bypass transport.
- Further research may be needed to optimize stroke care pathways and transport protocols.
Background:
Strokes are a leading cause of death worldwide, with a majority being ischemic. Treatments include intravenous thrombolytics and mechanical thrombectomy (MT) for large vessel occlusions. With both being time-sensitive, there has been a focus on emergency transport decisions; however, there is a deficit of large, multi-institutional studies to support the use of a bypass transport system where patients suspected of large vessel occlusion are transported directly to a comprehensive stroke center (CSC) even if they bypass other centers.
Methods:
A query was completed of PubMed, Scopus, and Web of Science for articles related to clinical outcomes with the bypass transport method. Patients directly transported to a CSC were compared to patients transferred from a peripheral stroke center. A mixed-effect meta-regression model was used to investigate the effect of patient and treatment variables on 90-day mortality and functional outcome rates.
Results:
Two hundred sixty articles were included in the final analysis. The time to tissue plasminogen activator treatment was insignificantly but slightly delayed in the direct group (132.1 vs. 130.6 minutes; P value: 0.8823), while the time to MT was significantly faster in the direct group (225.6 vs. 275.4 minutes; P value: 0.0114). Mortality and good neurological outcome rates were not significantly different in these groups (odds ratio=0.7060; 95% confidence interval 0.4802-1.0379 and odds ratio=1.1305; 95% confidence interval 0.8830-1.4473).
Conclusions:
This meta-analysis compares the 90-day mortality and functional outcomes between patients, and we found a statistically significant improvement in time to MT for those directly transported to a CSC; however, there was not a significant difference in clinical outcomes.
