Abstract
Background
In drip-and-ship protocols, non-invasive vascular imaging (NIVI) at Referral Centers
(RC), although recommended, is not consistently performed and its value is uncertain.
We evaluated the role of NIVI at RC, comparing patients with (VI+) and without (VI-)
vascular imaging in several outcomes.
Methods
Observational, multicenter study from a prospective government-mandated population-based
registry of code stroke patients. We selected acute ischemic stroke patients, initially
assessed at RC from January-2016 to June-2020. We compared and analyzed the rates
of patients transferred to a Comprehensive Stroke Center (CSC) for Endovascular Treatment
(EVT), rates of EVT and workflow times between VI+ and VI- patients.
Results
From 5128 ischemic code stroke patients admitted at RC; 3067 (59.8%) were VI+, 1822
(35.5%) were secondarily transferred to a CSC and 600 (11.7%) received EVT. Among
all patients with severe stroke (NIHSS ≥16) at RC, a multivariate analysis showed
that lower age, thrombolytic treatment, and VI+ (OR:1.479, CI95%: 1.117-1.960, p=0.006)
were independent factors associated to EVT.
The rate of secondary transfer to a CSC was lower in VI+ group (24.6% vs. 51.6%, p<0.001).
Among transferred patients, EVT was more frequent in VI+ than VI- (48.6% vs. 21.7%,
p<0.001).
Interval times as door-in door-out (median-minutes 83.5 vs. 82, p= 0.13) and RC-Door
to puncture (median-minutes 189 vs. 178, p= 0.47) did not show differences between
both groups.
Conclusion
In the present study, NIVI at RC improves selection for EVT, and is associated with
receiving EVT in severe stroke patients. Time-metrics related to drip-and-ship model
were not affected by NIVI.
Key Words
Abbreviations:
NIVI (Noninvasive vascular imaging), VI+ (Patients with noninvasive vascular imaging), VI- (Patients without noninvasive vascular imaging), RC (Referral Centers), CSC (Comprehensive Stroke Centers), EVT (Endovascular Treatment), LVO (Large Vessel Occlusion), CTA (Computed Angiography), DIDO (Door-in Door-out time), NIHSS (National Institutes of Health Stroke Scale), RACE (rapid arterial occlusion evaluation scale), rcDTP (RC-Door to CSC-Puncture time), CICAT (Codi Ictus Catalunya Registry)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 15, 2021
Accepted:
October 26,
2021
Received in revised form:
October 21,
2021
Received:
September 8,
2021
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106209
Copyright
© 2021 Elsevier Inc. All rights reserved.
