open access
Direct admission vs. secondary transfer for mechanical thrombectomy: long-term clinical outcomes from a single Polish Comprehensive Stroke Centre
- Department of Neurology, Medical University of Lublin, Poland
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Poland
- Department of Laboratory Diagnostics Medical University of Lublin, Poland
open access
Abstract
Introduction: We aimed to compare 3-month clinical outcomes after mechanical thrombectomy (MT) in patients transferred directly to a comprehensive stroke centre (‘mothership’, MS) to the outcomes of patients transferred secondarily from primary stroke centres (‘drip-and-ship’, DAS) in Lubelskie province, the third largest province in Poland. Material and methods: In a prospective stroke registry, all patients with large vessel occlusion in anterior circulation admitted within six hours of onset and treated with MT between 2017 and 2020 were retrospectively analysed. Results: A total of 400 patients was evaluated: 267 treated with the MS approach and 133 with the DAS approach. Time from stroke onset to groin puncture was shorter in the MS group. There was a significant difference in 3-month excellent clinical outcomes (mRS 0–1) between these two groups (32.9% of MS patients vs. 22.5% of DAS patients, p < 0.05), but there was no difference if the 3-month endpoint was expressed as mRS ≤ 2 (42.3% of MS vs. 34.5% of DAS patients, p = 0.13). The rate of symptomatic intracranial haemorrhage and mortality was comparable in both groups. Conclusions: Our study shows that direct admission to a comprehensive stroke centre resulted in more patients achieving excellent treatment outcomes (mRS 0–1). At the same time, the superiority of the MT model over the DAS model in obtaining mRS 0–2 was not unequivocally demonstrated. Further studies are needed to determine the best stroke model for patients potentially eligible for MT.
Abstract
Introduction: We aimed to compare 3-month clinical outcomes after mechanical thrombectomy (MT) in patients transferred directly to a comprehensive stroke centre (‘mothership’, MS) to the outcomes of patients transferred secondarily from primary stroke centres (‘drip-and-ship’, DAS) in Lubelskie province, the third largest province in Poland. Material and methods: In a prospective stroke registry, all patients with large vessel occlusion in anterior circulation admitted within six hours of onset and treated with MT between 2017 and 2020 were retrospectively analysed. Results: A total of 400 patients was evaluated: 267 treated with the MS approach and 133 with the DAS approach. Time from stroke onset to groin puncture was shorter in the MS group. There was a significant difference in 3-month excellent clinical outcomes (mRS 0–1) between these two groups (32.9% of MS patients vs. 22.5% of DAS patients, p < 0.05), but there was no difference if the 3-month endpoint was expressed as mRS ≤ 2 (42.3% of MS vs. 34.5% of DAS patients, p = 0.13). The rate of symptomatic intracranial haemorrhage and mortality was comparable in both groups. Conclusions: Our study shows that direct admission to a comprehensive stroke centre resulted in more patients achieving excellent treatment outcomes (mRS 0–1). At the same time, the superiority of the MT model over the DAS model in obtaining mRS 0–2 was not unequivocally demonstrated. Further studies are needed to determine the best stroke model for patients potentially eligible for MT.
Keywords
mothership, drip and ship, acute ischaemic stroke, mechanical thrombectomy, regional stroke care
Title
Direct admission vs. secondary transfer for mechanical thrombectomy: long-term clinical outcomes from a single Polish Comprehensive Stroke Centre
Journal
Neurologia i Neurochirurgia Polska
Issue
Article type
Short Communication
Pages
494-498
Published online
2021-07-23
Page views
6871
Article views/downloads
470
DOI
Pubmed
Bibliographic record
Neurol Neurochir Pol 2021;55(5):494-498.
Keywords
mothership
drip and ship
acute ischaemic stroke
mechanical thrombectomy
regional stroke care
Authors
Piotr Luchowski
Joanna Wojczal
Katarzyna Prus
Maciej Szmygin
Michał Sojka
Elżbieta Luchowska
Konrad Rejdak
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