Hospital ClĂ­nic of Barcelona
Comprehensive Stroke Center
Dr Salvatore Rudilosso is a stroke neurologist from the Hospital Clinic of Barcelona, and a fellow member of the ESO and WSO. His main fields of research are small vessel disease (SVD) and management of acute stroke. He completed his PhD program studying the hemodynamic perfusion patterns on CT perfusion in recent small subcortical infarcts (AJNR 2015; JCBFM 2019) and he is especially interested in studying SVD underlying mechanisms and clinical implications. To broaden his knowledge in the field of SVD, he completed a 6-month mobility research program grant at the Centre for Clinical Brain Sciences of the University of Edinburgh and participated in the recent ESO Guidelines on covert SVD (ESJ 2021). Dr Rudilosso also studied the usefulness of CT perfusion in assessing stroke mimics (Stroke 2020) and collaborated extensively in other studies focused on CT perfusion use. Dr Rudilosso has participated as an investigator in several RCTs of mechanical thrombectomy, secondary prevention in stroke and other collaborative works. He studied the prognostic value of neurologic improvement in patients treated with mechanical thrombectomy (Stroke 2019, JNIS 2020) and the efficacy of mechanical thrombectomy according to different prognostic profiles at baseline in a large population-based registry (accepted in JOS 2021).

Presenter 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).

Session Type
Free Communication Session
Date
28.10.2021, Thursday
Session Time
08:00 - 09:30
Room
FREE COMMUNICATIONS A
Lecture Time
08:00 - 08:10

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.

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