Interhospital Transfer for Endovascular Stroke Treatment in Canada: Results From the OPTIMISE Registry

Aristeidis H Katsanos¹, Alexandre Poppe², Rick H Swartz³, Jennifer Mandzia⁴, Luciana Catanese, Jai Shankar⁵, Samuel Yip⁶, Steve Verreault⁷, George Medvedev⁸, Ilavarasy Maran⁹, Catherine Legault¹⁰, Darren Ferguson¹¹, Brian Archer¹¹, Aditya Bharatha¹², David Volders¹³, Michael Kelly¹⁴, Federico Carpani¹⁵, Aleksandra Pikula¹⁵, Alexander Tkach¹⁶, Francois Moreau¹⁷, Michel Beaudry¹⁸, Ramana Appireddy¹⁹, Aviraj Deshmukh²⁰, Mohammed Almekhlafi²¹, Robert Fahed²², Noreen Kamal²³, Bijoy Menon²¹, Ashkan Shoamanesh¹, Heather Williams²⁴, Amy Y X Yu³, Manraj K S Heran²⁵, Michael D Hill²¹, Mukul Sharma¹, Karen Earl²⁶, Andrew M Demchuk²¹, Grant Stotts²²

Affiliations

¹ Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K., L.C., A.S., M.S.).
² Department of Neurosciences, Université de Montréal and Centre Hospitalier de l'Université de Montréal, QC, Canada (A. Poppe).
³ Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (R.H.S., A.Y.X.Y.).
⁴ Department of Clinical Neurological Sciences, London Health Sciences Centre and Western University, ON, Canada (J.M.).
⁵ Department of Radiology, University of Manitoba, Winnipeg, Canada (J.S.).
⁶ Division of Neurology (S.Y.), The University of British Columbia, Vancouver, Canada.
⁷ CHU de Québec, Hôpital de l'Enfant-Jésus, Montreal, Canada (S.V.).
⁸ University of British Columbia and the Fraser Health Authority, New Westminster, Canada (G.M.).
⁹ Department of Neurology, Trillium Health Partners, Missisauga, ON, Canada (I.M.).
¹⁰ Division of Neurology, McGill University Health Centre, Montreal, QC, Canada (C.L.).
¹¹ Department of Diagnostic Radiology, Dalhousie University, Saint John, NB, Canada (D.F., B.A.).
¹² Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada (A.B.).
¹³ Diagnostic Imaging, Dalhousie University, Halifax, NS, Canada (D.V.).
¹⁴ Department of Neurosurgery, University of Saskatchewan, Saskatoon, Canada (M.K.).
¹⁵ Toronto Western Hospital and the University of Toronto, ON, Canada (F.C., A. Pikula).
¹⁶ Kelowna General Hospital, BC, Canada (A.T.).
¹⁷ Université de Sherbrooke, QC, Canada (F.M.).
¹⁸ Centre de santé et de services sociaux de Chicoutimi, Saguenay, QC, Canada (M.B.).
¹⁹ Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada (R.A.).
²⁰ Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada (A.D.).
²¹ Department of Clinical Neurosciences, University of Calgary, AB, Canada (M.A., B.M., M.D.H., A.M.D.).
²² Division of Neurology, Department of Medicine, The Ottawa Hospital, ON, Canada (R.F., G.S.).
²³ Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada (N.K.).
²⁴ Queen Elizabeth Hospital, Charlottetown, PE, Canada (H.W.).
²⁵ Department of Radiology (M.K.S.H.), The University of British Columbia, Vancouver, Canada.
²⁶ Canadian Stroke Consortium, Oakville, ON (K.E.).

PMID: 39038099
DOI: 10.1161/STROKEAHA.124.046690

Free article

Interhospital Transfer for Endovascular Stroke Treatment in Canada: Results From the OPTIMISE Registry

Aristeidis H Katsanos et al. Stroke. 2024 Aug.

Free article

. 2024 Aug;55(8):2103-2112.

doi: 10.1161/STROKEAHA.124.046690. Epub 2024 Jul 22.

Authors

Affiliations

¹ Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K., L.C., A.S., M.S.).
² Department of Neurosciences, Université de Montréal and Centre Hospitalier de l'Université de Montréal, QC, Canada (A. Poppe).
³ Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (R.H.S., A.Y.X.Y.).
⁴ Department of Clinical Neurological Sciences, London Health Sciences Centre and Western University, ON, Canada (J.M.).
⁵ Department of Radiology, University of Manitoba, Winnipeg, Canada (J.S.).
⁶ Division of Neurology (S.Y.), The University of British Columbia, Vancouver, Canada.
⁷ CHU de Québec, Hôpital de l'Enfant-Jésus, Montreal, Canada (S.V.).
⁸ University of British Columbia and the Fraser Health Authority, New Westminster, Canada (G.M.).
⁹ Department of Neurology, Trillium Health Partners, Missisauga, ON, Canada (I.M.).
¹⁰ Division of Neurology, McGill University Health Centre, Montreal, QC, Canada (C.L.).
¹¹ Department of Diagnostic Radiology, Dalhousie University, Saint John, NB, Canada (D.F., B.A.).
¹² Department of Medical Imaging, St. Michael's Hospital, Unity Health Toronto, University of Toronto, ON, Canada (A.B.).
¹³ Diagnostic Imaging, Dalhousie University, Halifax, NS, Canada (D.V.).
¹⁴ Department of Neurosurgery, University of Saskatchewan, Saskatoon, Canada (M.K.).
¹⁵ Toronto Western Hospital and the University of Toronto, ON, Canada (F.C., A. Pikula).
¹⁶ Kelowna General Hospital, BC, Canada (A.T.).
¹⁷ Université de Sherbrooke, QC, Canada (F.M.).
¹⁸ Centre de santé et de services sociaux de Chicoutimi, Saguenay, QC, Canada (M.B.).
¹⁹ Division of Neurology, Department of Medicine, Queen's University, Kingston, ON, Canada (R.A.).
²⁰ Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada (A.D.).
²¹ Department of Clinical Neurosciences, University of Calgary, AB, Canada (M.A., B.M., M.D.H., A.M.D.).
²² Division of Neurology, Department of Medicine, The Ottawa Hospital, ON, Canada (R.F., G.S.).
²³ Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada (N.K.).
²⁴ Queen Elizabeth Hospital, Charlottetown, PE, Canada (H.W.).
²⁵ Department of Radiology (M.K.S.H.), The University of British Columbia, Vancouver, Canada.
²⁶ Canadian Stroke Consortium, Oakville, ON (K.E.).

PMID: 39038099
DOI: 10.1161/STROKEAHA.124.046690

Abstract

Background: Interhospital transfer for patients with stroke due to large vessel occlusion for endovascular thrombectomy (EVT) has been associated with treatment delays.

Methods: We analyzed data from Optimizing Patient Treatment in Major Ischemic Stroke With EVT, a quality improvement registry to support EVT implementation in Canada. We assessed for unadjusted differences in baseline characteristics, time metrics, and procedural outcomes between patients with large vessel occlusion transferred for EVT and those directly admitted to an EVT-capable center.

Results: Between January 1, 2018, and December 31, 2021, a total of 6803 patients received EVT at 20 participating centers (median age, 73 years; 50% women; and 50% treated with intravenous thrombolysis). Patients transferred for EVT (n=3376) had lower rates of M2 occlusion (22% versus 27%) and higher rates of basilar occlusion (9% versus 5%) compared with those patients presenting directly at an EVT-capable center (n=3373). Door-to-needle times were shorter in patients receiving intravenous thrombolysis before transfer compared with those presenting directly to an EVT center (32 versus 36 minutes). Patients transferred for EVT had shorter door-to-arterial access times (37 versus 87 minutes) but longer last seen normal-to-arterial access times (322 versus 181 minutes) compared with those presenting directly to an EVT-capable center. No differences in arterial access-to-reperfusion times, successful reperfusion rates (85% versus 86%), or adverse periprocedural events were found between the 2 groups. Patients transferred to EVT centers had a similar likelihood for good functional outcome (modified Rankin Scale score, 0-2; 41% versus 43%; risk ratio, 0.95 [95% CI, 0.88-1.01]; adjusted risk ratio, 0.98 [95% CI, 0.91-1.05]) and a higher risk for all-cause mortality at 90 days (29% versus 25%; risk ratio, 1.15 [95% CI, 1.05-1.27]; adjusted risk ratio, 1.14 [95% CI, 1.03-1.28]) compared with patients presenting directly to an EVT center.

Conclusions: Patients transferred for EVT experience significant delays from the time they were last seen normal to the initiation of EVT.

Keywords: humans; ischemic stroke; standard of care; stroke; thrombectomy.

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Conflict of interest statement

Alexandre Poppe reports grants from the Canadian Institutes of Health Research, compensation from Roche for other services, and grants from the Fondation Brain Canada, the Heart and Stroke Foundation of Canada, and Stryker. Dr Swartz reports grants from the Heart and Stroke Foundation of Canada, compensation from the Sunnybrook Research Institute for other services, compensation from F. Hoffmann-La Roche for consultant services, stock holdings in FollowMD, Inc, and grants from the Ontario Brain Institute and the National Institutes of Health. Dr Catanese reports compensation from Hoffmann-La Roche Limited for consultant services, employment by Hamilton Health Sciences, and grants from Servier Pharmaceuticals LLC. Dr Volders reports compensation from Penumbra, Inc, for consultant services. Dr Kelly reports compensation from Johnson and Johnson, Penumbra, Inc, and Medtronic Vascular, Inc, for consultant services. Dr Kamal reports stock holdings in DESTINE Health and compensation from Medtronic for consultant services. Dr Yu reports grants from the Canadian Institutes of Health Research. Dr Hill reports grants from NoNO, Inc, and Medtronic, compensation from Brainsgate Ltd for consultant services, grants from the Canadian Institutes of Health Research; Medtronic, Boehringer Ingelheim, Medtronic, and MicroVention, Inc, and compensation from Merck for end point review committee services. Dr Sharma reports grants from Bristol Myers Squibb Company to others and compensation from Bayer and AstraZeneca for consultant services. Dr Demchuk reports compensation from Hoffmann-La Roche Limited for consultant services, compensation from Lumosa for data and safety monitoring services, a patent issued for Stroke imaging software licensed to Circle NVI, compensation from Boehringer Ingelheim for consultant services, compensation from Novo Nordisk AS for other services, compensation from Philips for data and safety monitoring services, compensation from NovaSignal for consultant services, and stock holdings in Circle NVI.

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Interhospital Transfer for Endovascular Stroke Treatment in Canada: Results From the OPTIMISE Registry

Affiliations

Interhospital Transfer for Endovascular Stroke Treatment in Canada: Results From the OPTIMISE Registry

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical