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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 27, 2013
Direct Transport to a Comprehensive Stroke Center May Offer Outcome Benefits in Metropolitan Thrombectomy Networks
Péter Orosz1, Zoltán Kővári1, Henriette Mészáros2
1Department of Neurointervention, Centre of Neurosurgery and Neurointervention, Semmelweis University, Budapest, Hungary.
Journal of Stroke
|June 30, 2026
Summary
Direct transport to a comprehensive stroke center (CSC) improves outcomes for mechanical thrombectomy patients. This strategy reduces delays and enhances functional recovery and survival, even in networks with rapid access.
Area of Science:
- Neurology
- Public Health
- Emergency Medicine
Background:
- Optimal prehospital stroke care strategies, particularly for mechanical thrombectomy, are under investigation.
- Evaluating direct versus secondary transfer to a comprehensive stroke center (CSC) is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the impact of direct versus secondary transfer to a CSC on patient outcomes within a large metropolitan stroke network.
- To identify predictors of good functional outcome and survival after mechanical thrombectomy.
Main Methods:
- A prospective, registry-based cohort study of 2,017 patients undergoing thrombectomy between 2015 and 2022.
- Comparison of outcomes between directly transported patients (n=242) and secondarily transferred patients (n=1,775).
- Functional outcome assessed using the modified Rankin Scale (mRS) at 90 days; survival analyzed using Cox regression.
Main Results:
- Direct transport significantly reduced onset-to-CSC admission time (101 min vs. 240 min).
- Good functional outcome (mRS 0-2) was more frequent with direct transport (50.3% vs. 40.5%).
- Direct transport independently predicted better functional outcomes and improved long-term survival in patients receiving combined reperfusion therapy.
Conclusions:
- Direct transport to a CSC is superior within metropolitan networks, even with 1-hour access.
- This strategy shortens treatment delays, leading to better functional recovery.
- Direct transport enhances survival for patients undergoing combined thrombolysis and thrombectomy.
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