Objectives

Demand for thrombectomy, and interhospital transfer to comprehensive stroke centers (CSCs), for acute stroke is increasing. There is an urgent need to identify patients most likely to benefit from transfer. We evaluated whether CSC providers’ review of neuroimaging prior to transfer acceptance improved patient selection for thrombectomy and correlated with higher rates of treatment.

Materials and methods

A retrospective database of all patients transferred to Stanford's CSC for thrombectomy between 2015-2019 was used. Pre-acceptance images, when available for visual review, were reviewed by the CSC stroke team via virtual PACS, RAPID software, or LifeImage platforms.

Results

525 patients met inclusion criteria. 147 (28%) had neuroimaging available for review prior to transfer. Of those who did not recanalize en route, 267 (50.8%) underwent thrombectomy. Patients with imaging available for review prior to acceptance were significantly more likely to receive thrombectomy (68% vs 54%, RR 1.26; p=0.006, 95% CI 1.09-1.48). Patient images that were reviewed via RAPID were CT-based perfusion studies; these were more likely to receive thrombectomy (70% vs 54%, RR 1.30; p=0.01, 1.09-1.56). Patients who received EVT were more likely to have had pre-transfer vessel imaging, regardless of availability for visual review (76% vs 59%, RR 1.44; p<0.001, 1.18-1.76).

Conclusions

Patients with concern for acute stroke transferred for consideration of thrombectomy who had neuroimaging visually reviewed prior to transfer acceptance and did not recanalize by time of arrival were significantly more likely to undergo thrombectomy. Additional prospective studies are needed to confirm our findings.

中文翻译：

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在接受转移之前对急性中风神经影像学进行目视检查可增加血管内治疗的可能性

目标

对于急性卒中，对血栓切除术和院间转移到综合卒中中心 (CSC) 的需求正在增加。迫切需要确定最有可能从转移中受益的患者。我们评估了 CSC 提供者在接受转移之前对神经影像学的审查是否改善了血栓切除术的患者选择并与更高的治疗率相关。

材料和方法

使用了 2015-2019 年间转移到斯坦福 CSC 进行血栓切除术的所有患者的回顾性数据库。CSC 卒中团队通过虚拟 PACS、RAPID 软件或 LifeImage 平台对预验收图像进行视觉审查时进行审查。

结果

525 名患者符合纳入标准。147 人 (28%) 在转移前有神经影像学检查可供审查。在途中未再通的患者中，267 例 (50.8%) 接受了血栓切除术。在接受之前可以进行影像学检查的患者接受血栓切除术的可能性明显更大（68% 对 54%，RR 1.26；p=0.006，95% CI 1.09-1.48）。通过 RAPID 审查的患者图像是基于 CT 的灌注研究；这些人更有可能接受血栓切除术（70% 对 54%，RR 1.30；p=0.01，1.09-1.56）。接受 EVT 的患者更有可能进行转移前血管成像，无论视觉检查是否可用（76% 对 59%，RR 1.44；p<0.001，1.18-1.76）。

结论

担心急性卒中而转院考虑血栓切除术的患者，如果在接受转院前进行了神经影像学视觉检查，并且在到达时未再通，则更有可能接受血栓切除术。需要更多的前瞻性研究来证实我们的发现。