Xabier Urra (Spain)
Hospital Clínic de Barcelona Comprehensive Stroke CenterAuthor Of 1 Presentation
BENEFIT OF DIRECT TRANSFER TO AN ENDOVASCULAR VS. LOCAL STROKE CENTER IN ISCHEMIC STROKE PATIENTS WITH AND WITHOUT LARGE VESSEL OCCLUSION (RACECAT TRIAL SECONDARY ANALYSIS).
Abstract
Background and Aims
The RACECAT trial showed no superiority in transferring patients with high pre-hospital risk of large vessel occlusion (LVO) directly to an Endovascular Treatment Stroke Center (EVT-SC) compared to Local-SC. We explored whether patients with ischemic stroke might benefit from different transfer protocols according to the presence or absence of LVO.
Methods
From the modified intention-to-treat (m-ITT) population with final diagnosis of ischemic stroke (920/1401) we selected patients with available vascular imaging at first referring center. In LVO and no-LVO groups we analyzed the adjusted OR of EVT-SC transfer for better outcome (ordinal modified Rankin Scale) at 90-day follow-up, and compared the frequency of reperfusion therapies between both transfer protocols.
Results
Amongst the m-ITT population, 505 (55%) had LVO, 184 (20%) had no LVO, and 231 (25%) had undetermined LVO. Three hundred seven/505 LVO (61%) and 122/184 no-LVO (66%) patients were transferred directly to EVT-SC (p=0.187). The adjusted OR (95% CI) of EVT-SC transfer for better outcome was 0.86 (0.61-1.21) and 1.10 (0.62-1.93) in LVO and no-LVO groups, respectively. IV thrombolysis was administered more frequently in Local-SC (vs. EVT-SC) in both groups [LVO: 138 (70%) vs. 154 (50%), p<0.001; no-LVO: 39 (63%) vs. 56 (46%), p=0.029]. Thrombectomy was performed more frequently in LVO patients transferred directly to EVT-SC compared to Local-SC [212 (69%) vs. 109 (55%), p=0.001].
Conclusions
This exploratory analysis found no differences in functional outcome between both transfer models in the selected population of patients with final diagnosis of ischemic stroke independently of the presence or absence of LVO on vascular imaging.