One-Stop Management Improves Outcome for Large Vessel Occlusion Stroke

Time to mechanical thrombectomy (MT) is a critical predictor of functional outcomes in large vessel occlusion stroke. This study compares 2 large vessel occlusion stroke treatment approaches: the one-stop management approach (OSM), in which patients are directly transferred to the angiosuite for flat detector computed tomography and MT, versus the conventional approach, which includes multidetector CT before MT.

Between March 2014 and December 2019, 205 patients with acute ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score of ≥7 and symptom onset ≤4.5 hours underwent large vessel occlusion stroke-treatment using the OSM approach at the University Medical Center Göttingen, Germany. After confirmation of LVO, eligible patients received intravenous thrombolysis followed by MT. Ordinal regression corrected for all confounders. Primary end points included door-to-groin and door-to-reperfusion times, NIHSS at discharge, NIHSS improvement, and modified Rankin Scale at 90 days. Propensity score matching accounted for age, sex, NIHSS, thrombolysis, Thrombolysis in Cerebral Ischemia score, and post-MT intracranial hemorrhage. Treatment times were noncensored.

Compared with 2470 patients from the German Stroke Registry treated conventionally (non-OSM group), OSM patients had significantly shorter door-to-groin (33.33±±17.91 versus 95.73±±158.33 minutes; P<0.001) and door-to-reperfusion (78.06±±30.33 versus 147.47±±165.32 minutes; P<0.001) times. While baseline NIHSS was similar, OSM patients showed greater NIHSS improvement and better modified Rankin Scale at 90 days (OR, 2.26 [95% CI, 1.16-4.42]; P<0.05).

In this observational trial, direct angiosuite transfer for large vessel occlusion stroke treatment reduces periprocedural times and is associated with improved functional outcomes compared with a conventional approach using multidetector CT before MT.

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03356392.