Interfacility Transfer for Thrombectomy: A Promising Therapeutic Window

Pierre Seners^{1

2

3}, Jean-Claude Baron^{2

4}, Anke Wouters⁵, Jean-Philippe Desilles^{3

6

7}, Fernando Pico^{3

8

9}, Richard Macrez^{3

10}, Jean-Marc Olivot^{3

11}, Robin Lemmens⁵, Gregory W Albers¹², Maarten G Lansberg¹²

Affiliations

¹ Neurology Department, Rothschild Foundation Hospital, Paris, France (P.S.).
² Institut de Psychiatrie et Neurosciences de Paris, U1266, INSERM, France (P.S., J.-C.B.).
³ StrokeLink, French Clinical Research Infrastructure Network (F-CRIN), France (P.S., J.-P.D., F.P., R.M., J.-M.O.).
⁴ INSERM U1266, Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, France (J.-C.B.).
⁵ KU Leuven, Department of Neurosciences, Experimental Neurology; University Hospitals Leuven, Department of Neurology, Belgium (A.W., R.L.).
⁶ Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France (J.-P.D.).
⁷ Université Paris-Cité, FHU Neurovasc, INSERM 1144, France (J.-P.D.).
⁸ Neurology Department, Versailles University Hospital, France (F.P.).
⁹ Université Paris Saclay, France (F.P.).
¹⁰ Emergency Department, University hospital of Caen, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Institut Blood and Brain Normandie University, France (R.M.).
¹¹ Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, France (J.-M.O.).
¹² Stanford Stroke Center, Stanford University, Palo Alto, CA (G.W.A., M.G.L.).

PMID: 39502034
PMCID: PMC11772119 (available on 2026-02-01)
DOI: 10.1161/STROKEAHA.124.049167

Review

Interfacility Transfer for Thrombectomy: A Promising Therapeutic Window

Pierre Seners et al. Stroke. 2025 Feb.

. 2025 Feb;56(2):564-574.

doi: 10.1161/STROKEAHA.124.049167. Epub 2024 Nov 6.

Authors

Affiliations

¹ Neurology Department, Rothschild Foundation Hospital, Paris, France (P.S.).
² Institut de Psychiatrie et Neurosciences de Paris, U1266, INSERM, France (P.S., J.-C.B.).
³ StrokeLink, French Clinical Research Infrastructure Network (F-CRIN), France (P.S., J.-P.D., F.P., R.M., J.-M.O.).
⁴ INSERM U1266, Department of Neurology, GHU Paris Psychiatrie et Neurosciences, Université Paris Cité, France (J.-C.B.).
⁵ KU Leuven, Department of Neurosciences, Experimental Neurology; University Hospitals Leuven, Department of Neurology, Belgium (A.W., R.L.).
⁶ Interventional Neuroradiology Department, Rothschild Foundation Hospital, Paris, France (J.-P.D.).
⁷ Université Paris-Cité, FHU Neurovasc, INSERM 1144, France (J.-P.D.).
⁸ Neurology Department, Versailles University Hospital, France (F.P.).
⁹ Université Paris Saclay, France (F.P.).
¹⁰ Emergency Department, University hospital of Caen, UNICAEN, INSERM UMR-S U1237, Physiopathology and Imaging of Neurological Disorders, GIP Cyceron, Institut Blood and Brain Normandie University, France (R.M.).
¹¹ Acute Stroke Unit, Hôpital Pierre-Paul Riquet, CHU Toulouse and CIC 1436, Toulouse University, France (J.-M.O.).
¹² Stanford Stroke Center, Stanford University, Palo Alto, CA (G.W.A., M.G.L.).

PMID: 39502034
PMCID: PMC11772119 (available on 2026-02-01)
DOI: 10.1161/STROKEAHA.124.049167

Abstract

Currently, most acute ischemic stroke patients presenting with a large vessel occlusion are first evaluated at a nonthrombectomy-capable center before transfer to a comprehensive stroke center that performs thrombectomy. Interfacility transfer is a complex process that requires extensive coordination between the referring, transporting, and receiving facilities. As a result, long delays are common, contributing to poor clinical outcomes. In this review, we summarize the accumulating literature about the clinical as well as radiological-infarct growth, collateral change, arterial recanalization, and hemorrhagic transformation-changes during interfacility transfer for thrombectomy. Recent evidence shows that clinical/radiological changes during transfer are heterogeneous across patients and impact long-term functional outcomes, highlighting the urgent need to optimize care during this time window. We review some of the most promising therapeutic strategies-for example, penumbral protection to reduce infarct growth-that may improve clinical outcome in patients being transferred to thrombectomy-capable centers. Finally, we discuss key methodological considerations for designing clinical trials aimed at reducing infarct growth during transfer.

Keywords: arteries; infarction; ischemic stroke; stroke; thrombectomy.

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Conflict of interest statement

Dr Seners reports compensation from Acticor for consultant services. Dr Baron reports compensation from Frontiers in Neurology for other services and employment by Sainte-Anne Hospital, Paris. Dr Wouters reports grants from fonds Wetenschappelijk Onderzoek (FWO) travel grant and grants from Remmert Adriaan-Laan-Fonds. Dr Desilles reports compensation from Acticor Biotech for consultant services. Dr Olivot reports compensation from AbbVie, Boehringer Ingelheim, and Roche Diagnostics International Ltd for consultant services. Dr Lemmens reports compensation from iSchemaView for other services. Dr Albers reports compensation from Genentech and iSchemaView for consultant services; employment by Stanford University; and stock holdings in iSchemaView. Dr Lansberg reports compensation from F. Hoffmann-La Roche for consultant services. The other authors report no conflicts.

References

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1. Seners P, Khyheng M, Labreuche J, Lapergue B, Pico F. Inter-hospital transfer for thrombectomy: Transfer time is brain. Eur J Neurol. 2024:e16276. - PMC - PubMed
1. Guenego A, Mlynash M, Christensen S, Kemp S, Heit JJ, Lansberg MG, Albers GW. Hypoperfusion ratio predicts infarct growth during transfer for thrombectomy. Ann Neurol. 2018;84:616–620 - PubMed
1. Seners P, Scheldeman L, Christensen S, Mlynash M, Ter Schiphorst A, Arquizan C, Costalat V, Henon H, Bretzner M, Heit JJ, et al. Determinants of infarct core growth during inter-hospital transfer for thrombectomy. Ann Neurol. 2023;93:1117–1129 - PubMed
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Interfacility Transfer for Thrombectomy: A Promising Therapeutic Window

Affiliations

Interfacility Transfer for Thrombectomy: A Promising Therapeutic Window

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials