scholarly journals Endovascular thrombectomy for the treatment of ischemic stroke: An updated meta-analysis for a randomized controlled trial

2021 ◽  
Vol 9 (3) ◽  
pp. 166-176
Author(s):  
Jia Feng ◽  
Zhihan Zhu ◽  
Ahmed Waqas ◽  
Lukui Chen
Keyword(s):  
Ischemic Stroke ◽  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Meta Analysis ◽  
Intervention Group ◽  
Intravenous Thrombolysis ◽  
Control Group ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Objective:To evaluate whether endovascular thrombectomy combined with intravenous thrombolysis is superior to the standard treatment of intravenous thrombolysis for the treatment of ischemic stroke.Methods:A meta-analysis of 12 studies obtained by searching PubMed and Web of Science database was performed to determine whether the difference in mortality (within 7 days or 90 days), functional outcome (modified Rankin Scale, 0-2), hemorrhage (symptomatic intracerebral hemorrhage, and subarachnoid hemorrhage), and recurrent ischemic stroke rate at 90 days between patients who underwent mechanical intravenous thrombolysis with (intervention) and without (control) endovascular thrombectomy.Results:As compared with the control group, patients in the intervention group had lower 90-day mortality [summary risk ratio (RR) = 0.83, 95% confidence interval (CI): 0.69-0.99; n = 1309/1070], higher recanalization rate (RR = 2.24, 95% CI: 1.97-2.56; n = 504/497), better functional outcome (modified Rankin score: 0-2; RR = 1.41, 95% CI: 1.29-1.54; n = 1702/1502), and higher rate of subarachnoid hemorrhage (RR = 2.40, 95% CI: 1.45-3.99; n = 1046/875) without significant difference in the 7-day mortality (RR = 1.12, 95% CI: 0.84-1.50; n = 951/773), symptomatic intracranial hemorrhage (RR = 1.12, 95% CI: 0.82-1.54; n = 1707/1507), or recurrent ischemic stroke (RR = 0.90, 95% CI: 0.52-1.54; n = 718/506).Conclusion:Our results demonstrated that patients in the intervention group had lower mortality and better functional outcomes than the control group. Although patients in the intervention group had a higher rate of subarachnoid hemorrhage; hence, endovascular thrombectomy combined with intravenous thrombolysis is still a beneficial intervention for a defined population of stroke patients.

121 Endovascular Thrombectomy Alone versus Combined Intravenous Thrombolysis and Thrombectomy: A Systematic Review and Meta-Analysis

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 226-227
Author(s):  
Kevin Phan ◽  
Adam Dmytriw ◽  
Christoph Johannes Griessenauer ◽  
Justin M Moore ◽  
Christopher S Ogilvy ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Endovascular Thrombectomy ◽  
Safety Outcome ◽  
Relative Risks ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
Symptomatic Intracranial Hemorrhage ◽  
Iv Tpa

Abstract INTRODUCTION To date, no randomized trial has directly addressed the question of whether IV tPA improves the outcomes of IV tPA-eligible patients who will eventually undergo EVT or whether a direct EVT strategy will be equally effective. METHODS We performed a search on 6 electronic databases publications up until January 2017. All prospective and retrospective articles on comparing the efficacy and safety between mechanical thrombectomy (MT) alone and combined thrombectomy with IV tPA (MT + IVT) were included. The modified Rankin scale score between 0–2 at 90 days was used to analysed the primary efficacy whereby the primary safety outcome was all-cause mortality at 90 days. Summary relative risks and 95% confidence intervals calculated with a fixed-effects or random-effects model where appropriate. RESULTS >12 studies were included for analysis, comprising 1275 in the EVT only arm and 1340 in the combined EVT+IV tPA arm. Good functional outcomes (mRS = 2) was not statistically significant when comparing EVT versus EVT+IV tPA (44% vs 48%, OR 0.80, 95% CI 0.64, 1.002, P = 0.052). Similar findings was found in the primary safety outcome, 90-day mortality rates (20.4% vs 19.4%, OR 1.19, 95% CI 0.83, 1.71, P = 0.34). Symptomatic intracranial hemorrhage was also not significantly different between EVT versus EVT+IV tPA (3.7% vs 3.8%, OR 0.98, 95% CI 0.65-1.48, P = 0.91). CONCLUSION Overall, no significant difference was found between the groups in terms of favorable functional outcome, mortality rate or complications including symptomatic intracerebral hemorrhage. Our results suggest that a subset of acute ischemic stroke patients may benefit from a direct EVT alone approach.

EXPRESS: Comparison of Mothership versus Drip-and-Ship Models in treating patients with Acute Ischemic Stroke: A systematic review and meta-analysis

2021 ◽  
pp. 174749302110132
Author(s):  
Ahmed Mohamed ◽  
Nida Fatima ◽  
Ashfaq Shuaib ◽  
Maher Saqqur
Keyword(s):  
Functional Outcome ◽  
Meta Analysis ◽  
Critical Time ◽  
Functional Independence ◽  
Models Of Care ◽  
Randomized Control Trials ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
The Mean ◽  
Randomized Control

Introduction There is controversy if direct to comprehensive center “mothership” (MS) or stopping at primary center for thrombolysis before transfer to comprehensive center “drip-and- ship” (DS) are best models of treatment of acute stroke. In this study, we compare MS and DS models to evaluate the best option of functional outcome. Methods Studies between 1990 and 2020 were extracted from online electronic databases. We compared the clinical outcomes, critical time measurements, functional independence and mortality were then compared. Results A total of 7,824 patients’ data were retrieved from 13 publications (3 randomized control trials and 10 retrospective ones). 4,639 (59.3%) patients were treated under MS model and 3,185 (40.7%) followed the DS model with mean age of 70.01±3.58 vs. 69.03±3.36; p< 0 .001, respectively. The National Institute Health Stroke Scale was 15.57±3.83 for the MS and 15.72±2.99 for the DS model (p=<0.001). The mean symptoms onset-to-puncture time was significantly shorter in the MS group compared to the DS (159.69 min vs. 223.89 min; p=<0.001, respectively). Moreover, the collected data indicated no significant difference between symptom’s onset to intravenous (IV) thrombolysis time and stroke onset-to-successful recanalization time (p=0.205 and p=<0.001, respectively). Patients had significantly worse functional outcome [modified rankin score (mRS)] (3-6) at 90-days in the DS model [Odds Ratio (OR): 1.47, 95% Confidence Interval (CI): 1.13-1.92, p<0.004] and 1.49-folds higher likelihood of symptomatic intracerebral hemorrhage (OR: 1.49, 95%CI: 1.22-1.81, p<0.0001) compared to MS. However, there were no statistically significant difference in terms of mortality (OR: 1.16, 95%CI: 0.87-1.55, p=0.32) and successful recanalization (OR: 1.12, 95%CI: 0.76-1.65, p=0.56) between the two models of care. Conclusion Patients in the MS model have significantly improved functional independence and recovery. Further studies are needed as the data from prospectively randomized studies is not of sufficient quality to make definite recommendations.

Predictors of futile recanalization after endovascular treatment in acute ischemic stroke: a meta-analysis

2021 ◽  
pp. neurintsurg-2021-017963
Author(s):  
Gang Deng ◽  
Jun Xiao ◽  
Haihan Yu ◽  
Man Chen ◽  
Ke Shang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Systolic Blood Pressure ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Serum Glucose ◽  
Female Sex ◽  
Symptomatic Intracerebral Hemorrhage

BackgroundDespite successful recanalization after endovascular treatment, many patients with acute ischemic stroke due to large vessel occlusion still show functional dependence, namely futile recanalization.MethodsPubMed and Embase were searched up to April 30, 2021. Studies that reported risk factors for futile recanalization following endovascular treatment of acute ischemic stroke were included. The mean difference (MD) or odds ratio (OR) and 95% confidence interval (95% CI) of each study were pooled for a meta-analysis.ResultsTwelve studies enrolling 2138 patients were included. The pooled analysis showed that age (MD 5.81, 95% CI 4.16 to 7.46), female sex (OR 1.40, 95% CI 1.16 to 1.68), National Institutes of Health Stroke Scale (NIHSS) score (MD 4.22, 95% CI 3.38 to 5.07), Alberta Stroke Program Early CT Score (ASPECTS) (MD −0.71, 95% CI −1.23 to –0.19), hypertension (OR 1.73, 95% CI 1.43 to 2.09), diabetes (OR 1.78, 95% CI 1.41 to 2.24), atrial fibrillation (OR 1.24, 95% CI 1.01 to 1.51), admission systolic blood pressure (MD 4.98, 95% CI 1.87 to 8.09), serum glucose (MD 0.59, 95% CI 0.37 to 0.81), internal carotid artery occlusion (OR 1.85, 95% CI 1.17 to 2.95), pre-treatment intravenous thrombolysis (OR 0.67, 95% CI 0.55 to 0.83), onset-to-puncture time (MD 16.92, 95% CI 6.52 to 27.31), puncture-to-recanalization time (MD 12.37, 95% CI 7.96 to 16.79), and post-treatment symptomatic intracerebral hemorrhage (OR 6.09, 95% CI 3.18 to 11.68) were significantly associated with futile recanalization.ConclusionThis study identified female sex, comorbidities, admission systolic blood pressure, serum glucose, occlusion site, non-bridging therapy, and post-procedural complication as predictors of futile recanalization, and also confirmed previously reported factors. Further large-scale prospective studies are needed.

EXPRESS: Impact of renal impairment on short-term outcomes following endovascular thrombectomy for acute ischemic stroke: A systematic review and meta-analysis

2021 ◽  
pp. 174749302110473
Author(s):  
Jin Pyeong Jeon ◽  
Chih-Hao Chen ◽  
Fon-Yih Tsuang ◽  
Jianming Liu ◽  
Michael D Hill ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Renal Impairment ◽  
Acute Ischemic Stroke ◽  
Meta Analysis ◽  
Functional Independence ◽  
Continuous Variable ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage ◽  
The Impact

Background. The impact of renal impairment (RI) on the outcomes of patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) was relatively limited and contradictory. We performed a systematic review and meta-analysis to investigate this. Aims. We registered a protocol on September 2020 and searched MEDLINE, EMBASE, and Google Scholar accordingly. RI was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. Predefined outcomes included functional independence (defined as a modified Rankin Scale of 0, 1, or 2) at 3 months, successful reperfusion, mortality, and symptomatic intracerebral hemorrhage (sICH). Summary of review. Eleven studies involving 3453 patients were included. For the unadjusted outcomes, RI was associated with fewer functional independence (odds ratio (OR), 0.49; 95% confidence interval (CI), 0.39–0.62) and higher mortality (OR, 2.55; 95% CI, 2.03–3.21). RI was not associated with successful reperfusion (OR, 0.80; 95% CI 0.63–1.00) and sICH (OR, 1.41; 95% CI, 0.95–2.10). For the adjusted outcomes, results derived from a multivariate meta-analysis were consistent with the respective unadjusted outcomes: functional independence (OR, 0.59; 95% CI, 0.45–0.77), mortality (OR, 2.23, 95% CI, 1.45–3.43), and sICH (OR, 1.34; 95% CI, 0.85–2.10). Conclusions. We presented the first systematic review to demonstrate that RI is associated with fewer functional independence and higher mortality. Future EVT studies should publish complete renal eGFR data to facilitate prognostic studies and permit eGFR to be analyzed in a continuous variable. Systematic Review Registration: PROSPERO CRD42020191309

Corticosteroid as an Adjunct in the Treatment of Endobronchial Tuberculosis: A Systematic Review & Meta-analysis

2020 ◽  
Vol 16 (1) ◽  
pp. 53-60
Author(s):  
Nihar R. Mishra ◽  
Manoj K. Panigrahi ◽  
Girish C. Bhatt ◽  
Rashmi R. Das
Keyword(s):  
Adverse Events ◽  
Meta Analysis ◽  
Intervention Group ◽  
Oral Prednisolone ◽  
Oral Steroid ◽  
Control Group ◽  
Eligibility Criteria ◽  
Steroid Group ◽  
Significant Difference ◽  
Endobronchial Tuberculosis

Background: Corticosteroid exerts anti-inflammatory action and can prevent tissue damage resulting from various causes. Studies have shown that corticosteroids may prevent the damaging effect of tuberculosis (TB) in various organs, but there is no published meta-analysis specifically looking for the effect of corticosteroid in endobronchial TB. Objective: To synthesize the evidence regarding the usefulness of corticosteroid in endo-bronchial TB. Methods: A comprehensive search was performed of the major electronic databases till 30th November 2018. Randomized trials comparing treatment with corticosteroid as an adjunct to antitubercular drugs (ATT) versus placebo/no treatment in endobronchial TB were included. Three authors independently applied eligibility criteria, assessed the studies for methodological quality, and extracted data. The review is registered at PROSPERO database [CRD42016047063]. Results: Out of 525 search results, 4 trials including 205 patients (151 children) were eligible for inclusion. Oral prednisolone was used in various dose schedules. Rifampicin containing ATT regimen was used in 3 trials. The bronchoscopy findings showed no significant improvement at 1 month (effect size could not be calculated due to 0 event in the intervention group, p = 0.05), 2 months (RR 1.26, 95% CI 0.89 to 1.8), and at completion of ATT (RR 0.63, 95% CI 0.1 to 4.14) in steroid-treated group compared to the control group. The need for repeat bronchoscopy was significantly decreased in the steroid group (RR 0.13, 95% CI 0.02 to 0.9). Among the adverse events, the infection rate was significantly lesser in the steroid group (RR 0.53, 95% CI 0.29 to 0.97); but other adverse events (mortality, hypertension, and abdominal distension) showed no significant difference between the two groups. The GRADE evidence generated was of very low quality. Conclusions: The present meta-analysis showed that oral steroid does not help patients with endobronchial tuberculosis. However, the quality of evidence was very low. Future trials with robust design and a larger sample size would be required to provide any firm recommendation regarding the use of oral prednisolone in endobronchial tuberculosis.

Efficacy of Integrated Rehabilitation Techniques of Traditional Chinese Medicine for Ischemic Stroke: A Randomized Controlled Trial

2013 ◽  
Vol 41 (05) ◽  
pp. 971-981 ◽  
Author(s):  
Yong Zhang ◽  
He Jin ◽  
Dayong Ma ◽  
Yuanbo Fu ◽  
Yanming Xie ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Chinese Medicine ◽  
Traditional Chinese Medicine ◽  
Controlled Trial ◽  
Alternative Therapy ◽  
Intervention Group ◽  
Lower Limbs ◽  
Control Group ◽  
Significant Difference ◽  
Long Term Observation

This study aimed to determine the efficacy of Integrated Rehabilitation Techniques of Traditional Chinese Medicine (IRT-TCM) on patients with ischemic stroke as an alternative therapy to conventional rehabilitation techniques. Sixty-nine patients with ischemic stroke were randomly assigned to receive either IRT-TCM (intervention group, n = 46) or conventional rehabilitation techniques (control group, n = 23). The IRT-TCM consisted of a sequential combination of acupuncture and massage techniques. The Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Barthel index (BI) and modified Rankin Scale (mRS) were measured on day 0 (baseline, before treatment), day 21, and day 90. We observed that the scores in FMA and BI were increased, and NIHSS were decreased in both groups on day 21 and 90, compared with the baseline (day 0). Furthermore, significantly better scores in FMA of lower limbs and NIHSS were found in patients treated with IRT-TCM on day 21 and 90. For mRS, the percentage of patients ranking 0 and 1 in the intervention group presented a striking contrast to the control group on day 90 but with no significant difference. The results indicated that, as a feasible alternative therapy, IRT-TCM is beneficial for patients with ischemic stroke. Further research with larger sample size, long-term observation, and strict blinding are still in need to confirm the efficacy of IRT-TCM.

scholarly journals Music intervention affects the quality of life on Alzheimer’s disease: a meta-analysis

2021 ◽  
Author(s):  
Lingyan Zuo ◽  
Fengting Zhu ◽  
Rui Wang ◽  
Hongyan Shuai ◽  
Xin Yu
Keyword(s):  
Meta Analysis ◽  
Intervention Group ◽  
Original Data ◽  
Controlled Study ◽  
Control Group ◽  
Music Intervention ◽  
Significant Difference ◽  
Review Question ◽  
Intervention Modality ◽  
The Impact

Review question / Objective: Inclusion criteria: population: 1) A randomized controlled study on the impact of music intervention on the QOL of patients with AD; 2) The participants in this study is patients with AD; 3) There is no significant difference among age, gender and education background in sorted groups before analysis which make these groups comparable; intervention: 1)Intervention Modality Music-based intervention; comparison: 1) All data were sorted into two groups: the music intervention group and the control group without any music intervention; outcome: 1) The indicators evaluated in the literature included the score of QOL-AD or WHOQOL-BERF scale, at least one of the two scales summarized in selected publications; language: 1) Only articles published in English and Chinese were considered. Exclusion criteria: 1) The participants were not diagnosed with AD; 2) Non-musical intervention;3) Non-RCTs; 4) No specific values for outcome variables; 5) Articles lacking original data; 6) Repeat published reports; 7) Full text could not be obtained.

scholarly journals Intravenous fibrinolysis plus endovascular thrombectomy versus direct endovascular thrombectomy for anterior circulation acute ischemic stroke: clinical and infarct volume results.

2019 ◽  
Author(s):  
Massimo Gamba ◽  
Nicola Gilberti ◽  
Enrico Premi ◽  
Angelo Costa ◽  
Michele Frigerio ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Safety Profile ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Symptomatic Intracerebral Hemorrhage

Abstract Background and Purpose endovascular therapy (ET) is the standard of care for anterior circulation acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). The role of adjunctive intravenous thrombolysis (IVT) in these patients is still unclear. The present study aims to test whether IVT plus ET (CoT, combined therapy) provides additional benefits over direct ET for anterior circulation AIS by LVO. Methods we performed a single center retrospective observational study of patients with AIS caused by anterior circulation LVO, referred to our center between January 2014 and January 2017 and treated with ET. The patients were divided in 2 groups based on the treatment they received: CoT and, if IVT contraindicated, direct ET. We compared functional recovery (modified Rankin at 3-months follow-up), recanalization rate (thrombolysis in cerebral infarction [TICI] score) and time, early follow-up infarct volume (EFIV) (for recanalized patients only) as well as safety profile, defined as symptomatic intracerebral hemorrhage (sICH) and 3-month mortality, between groups. Results 145 subjects were included in the study, 70 in direct ET group and 75 in CoT group. Patients who received CoT presented more frequently a functional independence at 3-months follow-up compared to patients who received direct ET (mRS score 0-1: 48.5% vs 18.6%; P<0.001. mRS score 0-2: 67.1% vs 37.3%; P<0.001), higher first-pass success rate (62.7% vs 38.6%, P<0.05), higher recanalization rate (84.3% vs 65.3%; P=0.009) and, in recanalized subjects, smaller EFIV (16.4ml vs 62.3ml; P=0.003). The safety profile was similar for the 2 groups. In multivariable regression analysis, low baseline NIHSS score (P<0.05), vessel recanalization (P=0.05) and CoT (P=0.03) were indipendent predictors of 3-month favorable outcome. Conclusions CoT appears more effective than ET alone for anterior circulation AIS with LVO, with similar safety profile.

Meta-analysis of the Smoker’s Paradox in Acute Ischemic Stroke Patients Receiving Intravenous Thrombolysis or Endovascular Treatment

2019 ◽  
Vol 21 (9) ◽  
pp. 1181-1188 ◽  
Author(s):  
Peng Zhang ◽  
Zhen-Ni Guo ◽  
Xin Sun ◽  
Yingkai Zhao ◽  
Yi Yang
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Cochrane Library ◽  
Stroke Patients ◽  
Good Functional Outcome

Abstract Introduction The existence of the smoker’s paradox is controversial and potential mechanisms have not been explained. We aimed to explore the association between cigarette smoking and functional outcome at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis (IVT) or endovascular treatment (EVT). Methods This meta-analysis was conducted in accordance with the PRISMA guidelines. Studies exploring the association between smoking and good functional outcome (modified Rankin Scale score ≤ 2) following IVT or EVT were searched via the databases of PubMed, Embase, and the Cochrane Library from inception to August 8, 2018. Information on the characteristics of included studies was independently extracted by two investigators. Data were pooled using a random-effects or fixed-effects meta-analysis according to the heterogeneity of included studies. Results Among 20 identified studies, 15 reported functional outcomes following IVT, and five reported functional outcomes following EVT. Unadjusted analyses showed that smoking increased the odds of good functional outcomes with a pooled odds ratio (OR) of 1.48 (95% confidence interval [CI]: 1.36–1.60) after IVT and 2.10 (95% CI: 1.47–3.20) after EVT. Of IVT studies, only eight reported outcomes adjusted for covariates and none of the EVT studies reported adjusted outcomes. After adjustment, the relation between smoking and good functional outcome following IVT lost statistical significance (OR 1.14 [95% CI: 0.81–1.59]). Conclusion Our meta-analysis suggested that smoking was not associated with good functional outcome (mRS ≤ 2) at 3 months in patients with acute ischemic stroke who were treated with intravenous thrombolysis. Implications The existence of the smoker’s paradox is controversial. A previous letter by Plas et al. published in 2013 reported a positive result for the association between smoking and good functional outcome at 3 months in acute ischemic stroke patients who received intravenous thrombolysis (IVT). However, a major limitation of their meta-analysis was that the process of data synthesis was based on unadjusted data. Therefore, we conducted this meta-analysis to investigate the association based on adjusted data and a larger sample size. Our meta-analysis suggested that smoking was not associated with good functional outcome after adjusting for covariates.

scholarly journals Impact of interhospital transfer on patients undergoing endovascular thrombectomy for acute ischaemic stroke in an Australian setting

2020 ◽  
Vol 2 (1) ◽  
pp. e000030 ◽  
Author(s):  
Leon Stephen Edwards ◽  
Christopher Blair ◽  
Dennis Cordato ◽  
Alan McDougall ◽  
Nathan Manning ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Onset ◽  
Endovascular Thrombectomy ◽  
Interhospital Transfer ◽  
Significant Difference ◽  
The Impact

ObjectiveTo assess the impact of interhospital transfer on the interplay between functional outcome, mortality, reperfusion rates and workflow time metrics in patients undergoing endovascular thrombectomy (EVT) for acute ischaemic stroke due to large vessel occlusion (LVO) in the anterior cerebral circulation.Design, setting and participantsThis is an analysis of a prospective database of consecutive patients undergoing EVT for LVO presenting between January 2017 and December 2018 at a single Australian comprehensive stroke centre (CSC). Patients presented directly or were transferred to the CSC from 21 sites across New South Wales and the Australian Capital Territory.Main outcome measuresThe main outcome measures were rate of good 90-day functional outcome (modified Rankin Scale 0–2), successful reperfusion (Thrombolysis in Cerebral Infarction scale grade 2b or 3), symptomatic intracerebral haemorrhage (sICH) and 90-day mortality. Key workflow time metric milestones were examined.Results154 of 213 (72%) patients were interhospital transfers. There was no significant difference in baseline characteristics including age, National Institutes of Health Stroke Scale score, intravenous thrombolysis administration or procedure time between transferred and direct presenters (all p>0.05). Transferred patients had worse 90-day functional outcome (39.6% vs 61.0%, OR 0.42, 95% CI 0.23 to 0.78), higher mortality (25.3% vs 6.8%, OR 4.66, CI 1.59 to 13.70) and longer stroke onset to treatment (groin puncture) time (298 min vs 205 min, p<0.01). Successful reperfusion rates and sICH were similar between the cohorts (96.8% vs 98.3%, and 7.8% vs 3.4%).ConclusionInterhospital transfer is associated with longer stroke onset to treatment, worse 90-day functional outcome and higher mortality compared with patients presenting directly to the CSC.

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