Introduction

We aimed to identify factors associated with rapid infarct progression during inter-facility transfer for endovascular thrombectomy evaluation and its impact on clinical outcomes.

Methods

Patients with anterior circulation large artery occlusion within 24 h of onset transferred within our 17 hospital tele-stroke network were retrospectively analyzed. Patients were divided into fast progressors and slow progressors. Fast progressors were defined as CT ASPECTS score of ≥6 at the referring hospital (RH) and <6 at the hub hospital. Good clinical outcomes were defined as modified Rankin Scale score (mRS) 0–2 at 90 days. Demographic, clinical and radiologic variables associated with fast progressors and good clinical outcomes were identified using multivariable regression models.

Results

Among the 190 patients, 44 (23%) patients underwent rapid infarct progression. Higher stroke severity at presentation [aOR, 1.096, 95% CI,1.023, 1.174; p = 0.009], presence of early ischemic changes (CT ASPECT 6-9) at the RH [aOR, 2.721, 95% CI, 1.22, 6.071; p = 0.014] were positively associated, whereas prior ischemic stroke [aOR, 0.272, 95% CI, 0.078, 0.948; p = 0.04] and higher collateral score (2,3,4) [aOR, 0.138, 95%CI, 0.059, 0.324, p=<0.0001] were negatively associated with rapid infarct progression. Fifty-eight (31%) transferred patients had good outcomes. After adjusting for reperfusion status, age [aOR, 0.96, 95% CI, 0.93, 0.98; p=<0.001], initial stroke severity [aOR, 0.87, 95% CI, 0.81, 0.93; p=<0.001], absolute rate of decrease in CT ASPECTS [aOR, 0.38, 95% CI, 0.19, 0.77; p = 0.007] and internal carotid artery (ICA) occlusion [aOR, 0.34, 95 %CI, 0.12, 0.94; p = 0.038] were negatively associated with good outcome.

Conclusion

Higher stroke severity, presence of early ischemic changes at the referring facility, absence of prior stroke, and poor collateral scores (CS 0-1) are the factors associated with rapid infarct progression in the telemedicine transfer cohort. Increasing age, higher stroke severity, higher absolute decrease in CT ASPECTS and ICA occlusion determine poor clinical outcomes.

中文翻译：

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前循环大血管闭塞缺血性卒中患者在跨机构转移期间梗死的快速进展

介绍

我们旨在确定与设施间转移期间梗死快速进展相关的因素，以进行血管内血栓切除术评估及其对临床结果的影响。

方法

回顾性分析了在我们 17 家医院远程卒中网络内转诊的发病 24 小时内发生前循环大动脉闭塞的患者。患者分为快速进展者和缓慢进展者。快速进展者定义为转诊医院 (RH) 的 CT ASPECTS 评分≥6 且中心医院的 CT ASPECTS 评分 <6。良好的临床结果定义为 90 天时改良 Rankin 量表评分 (mRS) 0-2。使用多变量回归模型确定与快速进展者和良好临床结果相关的人口统计学、临床和放射学变量。

结果

在 190 名患者中，44 名 (23%) 患者经历了快速的梗塞进展。就诊时卒中严重程度较高 [aOR, 1.096, 95% CI,1.023, 1.174; p  = 0.009]，RH 处存在早期缺血性改变 (CT ASPECT 6-9) [aOR, 2.721, 95% CI, 1.22, 6.071; p  = 0.014] 呈正相关，而既往缺血性卒中 [aOR, 0.272, 95% CI, 0.078, 0.948; p = 0.04] 和较高的侧支评分 (2,3,4) [aOR, 0.138, 95%CI, 0.059, 0.324, p=<0.0001] 与快速梗塞进展呈负相关。五十八名 (31%) 转移的患者有良好的结果。调整再灌注状态后，年龄 [aOR, 0.96, 95% CI, 0.93, 0.98; p=<0.001]，初始卒中严重程度 [aOR, 0.87, 95% CI, 0.81, 0.93; p=<0.001]，CT 方面的绝对下降率 [aOR, 0.38, 95% CI, 0.19, 0.77; p  = 0.007] 和颈内动脉 (ICA) 闭塞 [aOR, 0.34, 95 %CI, 0.12, 0.94; p  = 0.038] 与良好的结果呈负相关。

结论

较高的卒中严重程度、转诊机构早期缺血性改变的存在、既往无卒中和较差的侧支评分 (CS 0-1) 是远程医疗转移队列中与梗死快速进展相关的因素。年龄增加、卒中严重程度更高、CT ASPECTS 绝对下降幅度更大以及 ICA 闭塞决定了较差的临床结果。