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Updated: Jan 27, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

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Bypass of Primary Stroke Centers Compared With Secondary Transfer for Endovascular Thrombectomy

Jae Beom Hong1,2, William K Diprose1,2, Michael T M Wang1

  • 1Department of Medicine Faculty of Medical and Health Sciences University of Auckland Auckland New Zealand.

Stroke (Hoboken, N.J.)
|January 26, 2026
PubMed

Insights

Direct bypass to endovascular thrombectomy-capable stroke centers (EVT-SC) improves outcomes for large-vessel occlusion stroke patients compared to transfer via primary stroke centers (PSC). This approach reduces treatment times and enhances functional independence.

Area of Science:

  • Neurology
  • Emergency Medicine
  • Public Health

Background:

  • Stroke networks utilize hybrid models for large-vessel occlusion (LVO) treatment.
  • Patients are routed to primary stroke centers (PSC) or directly to endovascular thrombectomy-capable stroke centers (EVT-SC) based on time of day.
  • This study compares the effectiveness of these two transfer methods.

Purpose of the Study:

  • To compare the clinical outcomes of direct bypass to EVT-SC versus secondary transfer from PSC for LVO patients.
  • To evaluate process times and functional independence after endovascular thrombectomy (EVT).

Main Methods:

  • Retrospective analysis of consecutive LVO patients treated with EVT (August 2017-February 2021).
  • Patients were grouped into 'EVT-SC direct' or 'PSC-transfer' based on initial presentation.
  • Primary outcome: 3-month functional independence (modified Rankin Scale 0-2); secondary outcomes: mortality.

Main Results:

  • Direct bypass to EVT-SC was associated with significantly shorter times to thrombolysis and puncture.
  • EVT-SC direct patients demonstrated greater 3-month functional independence (OR 2.04) and lower 3-month mortality (OR 0.33).
  • For every 100 patients, direct bypass resulted in 14 more independent survivors and 9 fewer deaths.

Conclusions:

  • Direct bypass to EVT-SC offers superior process times and clinical outcomes compared to secondary transfers from PSCs.
  • This organizational strategy is more effective for LVO stroke patients.
  • Optimizing patient pathways to EVT-SC is crucial for improving stroke care outcomes.
Abstract

Keywords:
emergency medical servicesstrokethrombectomy

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