Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York
Background Faster time to treatment for stroke is associated with improved outcomes. In cases of large vessel occlusion (LVO), standard of care treatment with thrombectomy can only be provided at a comprehensive stroke center (CSC). We examine the outcomes of patients who are directly brought to our...
Gespeichert in:
| Veröffentlicht in: | Interventional neuroradiology 2023-05, p.15910199231177763-15910199231177763 |
|---|---|
| Hauptverfasser: | , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 15910199231177763 |
|---|---|
| container_issue | |
| container_start_page | 15910199231177763 |
| container_title | Interventional neuroradiology |
| container_volume | |
| creator | Khazen, Olga Bao, Jonathan Gajjar, Avi A Entezami, Pouya Dalfino, John C Feustel, Paul J Paul, Alexandra R |
| description | Background
Faster time to treatment for stroke is associated with improved outcomes. In cases of large vessel occlusion (LVO), standard of care treatment with thrombectomy can only be provided at a comprehensive stroke center (CSC). We examine the outcomes of patients who are directly brought to our center, a CSC, compared to those seen at a primary stroke center (PSC) and then transferred.
Methods
Patients with LVO presenting to our center from 1/1/2019 to 12/31/2019 were included. Cohorts of patients presenting first to a PSC and presenting first to a CSC were compared. Demographics and outcome metrics (Discharge Modified Rankin Scale (mRS) and National Institute of Health Stroke Severity Scale (NIHSS) scores) were obtained for all LVO patients. Imaging was also assessed.
Results
Of 864 stroke admissions, 346 had LVO (40%) with 183 (53%) transferring from a PSC and 163 (47%) presenting directly. Similar percentages of each cohort were taken for thrombectomy (25.1% transfer and 31.3% direct). However, as distance between PSC and CSC increased, likelihood of thrombectomy decreased. Transfer patients were more likely to be excluded from thrombectomy secondary to a large volume of complete stroke (p = 0.0001). Direct presenters had lower discharge mRS scores than transfer patients (p |
| doi_str_mv | 10.1177/15910199231177763 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2820029996</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_15910199231177763</sage_id><sourcerecordid>2820029996</sourcerecordid><originalsourceid>FETCH-LOGICAL-c292t-4f0bf3b9c183e2b291df6ed66b62f41994d97d7a6630fbcd7a7d0b3571d2e2be3</originalsourceid><addsrcrecordid>eNp9kctOGzEUhq2KqglpH6Cbyks2Q31JPPGyiqAgoXZTFqxGvhwnQ2bswfYE5aF4xzpKYFGkruwjf985Ov4R-krJJaV1_Z0uJCVUSsYPZS34BzRlfLmoGKH0DE0P79UBmKDzlB4JEQsu6Sc04XVRxFxM0cutN60FbwAHh3swG-VbozqcNzH0GkwO_R6rPvg1TjmGLeBB5RZ8TljHMK43Gds2Fq7b4xywwib0Q4QN-NTu4NUxRYCIdxDTmHCOyidXaldmFGWIba_i_h-49XgcUlYZ8C94xg8hbj-jj051Cb6czhm6v776s7qp7n7_vF39uKsMkyxXc0e041oauuTANJPUOgFWCC2Ym5f_mFtZ21oJwYnTptxqSzRf1NSywgOfoYtj3yGGpxFSbvo2Geg65SGMqWFLRgiTUoqC0iNqYkgpgmtO2zSUNIdYmncpFefbqf2oe7BvxmssBbg8AkmtoXkMY_Rl3f90_AspQp9G</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2820029996</pqid></control><display><type>article</type><title>Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York</title><source>SAGE Complete A-Z List</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central</source><creator>Khazen, Olga ; Bao, Jonathan ; Gajjar, Avi A ; Entezami, Pouya ; Dalfino, John C ; Feustel, Paul J ; Paul, Alexandra R</creator><creatorcontrib>Khazen, Olga ; Bao, Jonathan ; Gajjar, Avi A ; Entezami, Pouya ; Dalfino, John C ; Feustel, Paul J ; Paul, Alexandra R</creatorcontrib><description>Background
Faster time to treatment for stroke is associated with improved outcomes. In cases of large vessel occlusion (LVO), standard of care treatment with thrombectomy can only be provided at a comprehensive stroke center (CSC). We examine the outcomes of patients who are directly brought to our center, a CSC, compared to those seen at a primary stroke center (PSC) and then transferred.
Methods
Patients with LVO presenting to our center from 1/1/2019 to 12/31/2019 were included. Cohorts of patients presenting first to a PSC and presenting first to a CSC were compared. Demographics and outcome metrics (Discharge Modified Rankin Scale (mRS) and National Institute of Health Stroke Severity Scale (NIHSS) scores) were obtained for all LVO patients. Imaging was also assessed.
Results
Of 864 stroke admissions, 346 had LVO (40%) with 183 (53%) transferring from a PSC and 163 (47%) presenting directly. Similar percentages of each cohort were taken for thrombectomy (25.1% transfer and 31.3% direct). However, as distance between PSC and CSC increased, likelihood of thrombectomy decreased. Transfer patients were more likely to be excluded from thrombectomy secondary to a large volume of complete stroke (p = 0.0001). Direct presenters had lower discharge mRS scores than transfer patients (p < 0.01), however, severity of stroke upon admission was similar in the two groups.
Conclusion
Patients transferred from a PSC were more likely to have a worse outcome at time of discharge than those presenting directly to our center. Large volume of completed stroke was a frequent reason for exclusion from thrombectomy. Optimizing stroke protocols to CSC in cases of LVOs may result in better outcomes.</description><identifier>ISSN: 1591-0199</identifier><identifier>EISSN: 2385-2011</identifier><identifier>DOI: 10.1177/15910199231177763</identifier><identifier>PMID: 37231646</identifier><language>eng</language><publisher>London, England: SAGE Publications</publisher><ispartof>Interventional neuroradiology, 2023-05, p.15910199231177763-15910199231177763</ispartof><rights>The Author(s) 2023</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c292t-4f0bf3b9c183e2b291df6ed66b62f41994d97d7a6630fbcd7a7d0b3571d2e2be3</cites><orcidid>0000-0003-0208-049X ; 0000-0002-8315-5870</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/15910199231177763$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/15910199231177763$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21798,27901,27902,43597,43598</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37231646$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khazen, Olga</creatorcontrib><creatorcontrib>Bao, Jonathan</creatorcontrib><creatorcontrib>Gajjar, Avi A</creatorcontrib><creatorcontrib>Entezami, Pouya</creatorcontrib><creatorcontrib>Dalfino, John C</creatorcontrib><creatorcontrib>Feustel, Paul J</creatorcontrib><creatorcontrib>Paul, Alexandra R</creatorcontrib><title>Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York</title><title>Interventional neuroradiology</title><addtitle>Interventional Neuroradiology</addtitle><description>Background
Faster time to treatment for stroke is associated with improved outcomes. In cases of large vessel occlusion (LVO), standard of care treatment with thrombectomy can only be provided at a comprehensive stroke center (CSC). We examine the outcomes of patients who are directly brought to our center, a CSC, compared to those seen at a primary stroke center (PSC) and then transferred.
Methods
Patients with LVO presenting to our center from 1/1/2019 to 12/31/2019 were included. Cohorts of patients presenting first to a PSC and presenting first to a CSC were compared. Demographics and outcome metrics (Discharge Modified Rankin Scale (mRS) and National Institute of Health Stroke Severity Scale (NIHSS) scores) were obtained for all LVO patients. Imaging was also assessed.
Results
Of 864 stroke admissions, 346 had LVO (40%) with 183 (53%) transferring from a PSC and 163 (47%) presenting directly. Similar percentages of each cohort were taken for thrombectomy (25.1% transfer and 31.3% direct). However, as distance between PSC and CSC increased, likelihood of thrombectomy decreased. Transfer patients were more likely to be excluded from thrombectomy secondary to a large volume of complete stroke (p = 0.0001). Direct presenters had lower discharge mRS scores than transfer patients (p < 0.01), however, severity of stroke upon admission was similar in the two groups.
Conclusion
Patients transferred from a PSC were more likely to have a worse outcome at time of discharge than those presenting directly to our center. Large volume of completed stroke was a frequent reason for exclusion from thrombectomy. Optimizing stroke protocols to CSC in cases of LVOs may result in better outcomes.</description><issn>1591-0199</issn><issn>2385-2011</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNp9kctOGzEUhq2KqglpH6Cbyks2Q31JPPGyiqAgoXZTFqxGvhwnQ2bswfYE5aF4xzpKYFGkruwjf985Ov4R-krJJaV1_Z0uJCVUSsYPZS34BzRlfLmoGKH0DE0P79UBmKDzlB4JEQsu6Sc04XVRxFxM0cutN60FbwAHh3swG-VbozqcNzH0GkwO_R6rPvg1TjmGLeBB5RZ8TljHMK43Gds2Fq7b4xywwib0Q4QN-NTu4NUxRYCIdxDTmHCOyidXaldmFGWIba_i_h-49XgcUlYZ8C94xg8hbj-jj051Cb6czhm6v776s7qp7n7_vF39uKsMkyxXc0e041oauuTANJPUOgFWCC2Ym5f_mFtZ21oJwYnTptxqSzRf1NSywgOfoYtj3yGGpxFSbvo2Geg65SGMqWFLRgiTUoqC0iNqYkgpgmtO2zSUNIdYmncpFefbqf2oe7BvxmssBbg8AkmtoXkMY_Rl3f90_AspQp9G</recordid><startdate>20230525</startdate><enddate>20230525</enddate><creator>Khazen, Olga</creator><creator>Bao, Jonathan</creator><creator>Gajjar, Avi A</creator><creator>Entezami, Pouya</creator><creator>Dalfino, John C</creator><creator>Feustel, Paul J</creator><creator>Paul, Alexandra R</creator><general>SAGE Publications</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0208-049X</orcidid><orcidid>https://orcid.org/0000-0002-8315-5870</orcidid></search><sort><creationdate>20230525</creationdate><title>Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York</title><author>Khazen, Olga ; Bao, Jonathan ; Gajjar, Avi A ; Entezami, Pouya ; Dalfino, John C ; Feustel, Paul J ; Paul, Alexandra R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c292t-4f0bf3b9c183e2b291df6ed66b62f41994d97d7a6630fbcd7a7d0b3571d2e2be3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khazen, Olga</creatorcontrib><creatorcontrib>Bao, Jonathan</creatorcontrib><creatorcontrib>Gajjar, Avi A</creatorcontrib><creatorcontrib>Entezami, Pouya</creatorcontrib><creatorcontrib>Dalfino, John C</creatorcontrib><creatorcontrib>Feustel, Paul J</creatorcontrib><creatorcontrib>Paul, Alexandra R</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Interventional neuroradiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khazen, Olga</au><au>Bao, Jonathan</au><au>Gajjar, Avi A</au><au>Entezami, Pouya</au><au>Dalfino, John C</au><au>Feustel, Paul J</au><au>Paul, Alexandra R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York</atitle><jtitle>Interventional neuroradiology</jtitle><addtitle>Interventional Neuroradiology</addtitle><date>2023-05-25</date><risdate>2023</risdate><spage>15910199231177763</spage><epage>15910199231177763</epage><pages>15910199231177763-15910199231177763</pages><issn>1591-0199</issn><eissn>2385-2011</eissn><abstract>Background
Faster time to treatment for stroke is associated with improved outcomes. In cases of large vessel occlusion (LVO), standard of care treatment with thrombectomy can only be provided at a comprehensive stroke center (CSC). We examine the outcomes of patients who are directly brought to our center, a CSC, compared to those seen at a primary stroke center (PSC) and then transferred.
Methods
Patients with LVO presenting to our center from 1/1/2019 to 12/31/2019 were included. Cohorts of patients presenting first to a PSC and presenting first to a CSC were compared. Demographics and outcome metrics (Discharge Modified Rankin Scale (mRS) and National Institute of Health Stroke Severity Scale (NIHSS) scores) were obtained for all LVO patients. Imaging was also assessed.
Results
Of 864 stroke admissions, 346 had LVO (40%) with 183 (53%) transferring from a PSC and 163 (47%) presenting directly. Similar percentages of each cohort were taken for thrombectomy (25.1% transfer and 31.3% direct). However, as distance between PSC and CSC increased, likelihood of thrombectomy decreased. Transfer patients were more likely to be excluded from thrombectomy secondary to a large volume of complete stroke (p = 0.0001). Direct presenters had lower discharge mRS scores than transfer patients (p < 0.01), however, severity of stroke upon admission was similar in the two groups.
Conclusion
Patients transferred from a PSC were more likely to have a worse outcome at time of discharge than those presenting directly to our center. Large volume of completed stroke was a frequent reason for exclusion from thrombectomy. Optimizing stroke protocols to CSC in cases of LVOs may result in better outcomes.</abstract><cop>London, England</cop><pub>SAGE Publications</pub><pmid>37231646</pmid><doi>10.1177/15910199231177763</doi><orcidid>https://orcid.org/0000-0003-0208-049X</orcidid><orcidid>https://orcid.org/0000-0002-8315-5870</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1591-0199 |
| ispartof | Interventional neuroradiology, 2023-05, p.15910199231177763-15910199231177763 |
| issn | 1591-0199 2385-2011 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2820029996 |
| source | SAGE Complete A-Z List; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| title | Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-06T17%3A46%3A29IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Incidence%20of%20mechanical%20thrombectomy%20among%20stroke%20patients%20brought%20directly%20to%20a%20comprehensive%20stroke%20center%20versus%20transfer%20from%20a%20primary%20stroke%20center%20in%20upstate%20New%20York&rft.jtitle=Interventional%20neuroradiology&rft.au=Khazen,%20Olga&rft.date=2023-05-25&rft.spage=15910199231177763&rft.epage=15910199231177763&rft.pages=15910199231177763-15910199231177763&rft.issn=1591-0199&rft.eissn=2385-2011&rft_id=info:doi/10.1177/15910199231177763&rft_dat=%3Cproquest_cross%3E2820029996%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2820029996&rft_id=info:pmid/37231646&rft_sage_id=10.1177_15910199231177763&rfr_iscdi=true |