Direct-to-Angio Without Any Repeat Neuroimaging for Planned Endovascular Therapy in Patients Transferred From Remote...

Repeat imaging when regional and remote patients with stroke arrive at a comprehensive stroke center can delay endovascular thrombectomy. We examined outcomes amongs patients transferred for endovascular therapy from nonmetropolitan primary stroke centers.

In this prospective observational study patients who were transferred from remote nonmetropolitan hospitals with large vessel occlusion were recruited between 2020-2023. The control group was defined as patients with repeat neuroimaging at the comprehensive stroke center in the radiology/emergency department. Direct-to-angio (direct to angiography) included patients who proceeded directly to the angiography suite without any repeat neuroimaging or routine flat panel computed tomography. Logistic regression with propensity matching was performed to assess factors associated with 3-month independent outcome (modified Rankin scale score 0-2). A secondary analysis was performed to assess factors associated with recanalization.

Between June 2020 and February 2023, 227 patients with large vessel occlusion were transferred for endovascular clot retrieval. A total of 47 (26%) patients recanalized by time of arrival and 180 had persistent large vessel occlusion. Primary stroke centers were a median distance of 185 km from the comprehensive stroke center (interquartile range 130-256). After propensity matching 138 patients remained. Characteristics between direct-to-angio and control groups were similar with regard to age (68 versus 66), primary stroke centers National Institutes of Health Stroke Scale score (15 versus 13), and onset to referral (200 versus 246 min). Direct-to-angio increased independent functional outcome at 3 months (adjusted odds ratio, 2.2 [95% CI, 1.0-4.9]; P = 0.05). Direct-to-angio resulted in shorter door-to arterial puncture time (43 versus 77 min, P<0.001) and a higher likelihood of receiving endovascular therapy (100% versus 65%, P<0.001).

In patients who have already received telestroke review at the primary stroke centers, our results suggest a direct-to-angio approach is likely to result in better outcomes.