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Observational Study
. 2023 Jun;15(6):517-520.
doi: 10.1136/neurintsurg-2021-018049. Epub 2022 May 2.

Transferring neurointerventionalists saves time compared with interhospital transfer of stroke patients for endovascular thrombectomy: a collaborative pooled analysis of 1001 patients (EVEREST)

Fatih Seker  1 , Johanna T Fifi  2 , Jacob R Morey  2 , Toshiya Osanai  3 , Sogo Oki  3 , Caspar Brekenfeld  4 , Jens Fiehler  4 , Martin Bendszus  1 , Markus A Möhlenbruch  5
Affiliations
Observational Study

Transferring neurointerventionalists saves time compared with interhospital transfer of stroke patients for endovascular thrombectomy: a collaborative pooled analysis of 1001 patients (EVEREST)

Fatih Seker et al. J Neurointerv Surg. 2023 Jun.

Abstract

Background: Interhospital transfer of stroke patients (drip and ship concept) is associated with longer treatment times compared with primary admission to a comprehensive stroke center (mothership concept). In recent years, studies on a novel concept of performing endovascular thrombectomy (EVT) at external hospitals (EXT) by transferring neurointerventionalists, instead of patients, have been published. This collaborative study aimed at answering the question of whether EXT saves time in the workflow of acute stroke treatment across various geographical regions.

Methods: This was a patient level pooled analysis of one prospective observational study and four retrospective cohort studies, the EVEREST collaboration (EndoVascular thrombEctomy at Referring and External STroke centers). Time from initial stroke imaging to EVT (vascular puncture) was compared in mothership, drip and ship, and EXT concepts.

Results: In total, 1001 stroke patients from various geographical regions who underwent EVT due to large vessel occlusion were included. These were divided into mothership (n=162, 16.2%), drip and ship (n=458, 45.8%), and EXT (n=381, 38.1%) cohorts. The median time periods from onset to EVT (195 min vs 320 min, p<0.001) and from imaging to EVT (97 min vs 184 min, p<0.001) in EXT were significantly shorter than for drip and ship thrombectomy concept.

Conclusions: This pooled analysis of the EVEREST collaboration adds evidence that performing EVT at external hospitals can save time compared with drip and ship across various geographical regions. We encourage conducting randomized controlled trials comparing both triage concepts.

Keywords: Stroke; Thrombectomy.

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Conflict of interest statement

Competing interests: FS: research support from Stryker and member of the editorial board of JNIS. JF: research support from German Ministry of Science and Education (BMBF), German Ministry of Economy and Innovation (BMWi), German Research Foundation (DFG), European Union (EU), Hamburgische Investitions-und Förderbank (IFB), Medtronic, Microvention, Philips, and Stryker; consultant for Acandis, Boehringer Ingelheim, Cerenovus, Covidien, Evasc Neurovascular, MD Clinicals, Medtronic, Medina, Microvention, Penumbra, Route92, Stryker, and Transverse Medical; and member of the editorial board of JNIS. MAM: unrelated: board membership of Codman; consultancy for Medtronic, MicroVention, and Stryker; grants/grants pending from Balt, and MicroVention (money paid to the institution); payment for lectures including service on speakers bureaus for Medtronic, MicroVention, and Stryker. MB: (all unrelated): research support from Stryker, European Union, DFG, Hopp Foundation, Novartis, and Siemens; consultancy for Vascular Dynamics, Boehringer, and BBraun; personal fees from Novartis, Grifols, Merck, TEVA and Bayer.

Figures

Figure 1
Figure 1
Box plot demonstrating time from stroke imaging to thrombectomy (vascular puncture) in the three cohorts: mothership (MS), drip and ship (DS), and thrombectomy at external hospital (EXT).
See this image and copyright information in PMC

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