Prehospital and Emergency Care

By Matthew E. Fink, MD, Editor

Feil Professor and Chairman, Department of Neurology, and Assistant Dean of Clinical Affairs, Weill Cornell Medical College; Neurologist-in-Chief, New York Presbyterian Hospital

Dr. Fink reports he is a consultant for Procter & Gamble.

Endovascular Therapy

Michael Froehler, from Nashville, TN, presented the results of the STRATIS Registry, which is a prospective, multicenter, observational, single-arm registry of large vessel occlusion stroke patients treated by endovascular therapy with the SOLITAIRE stent retrieval device. The patients were separated into two groups: 1) direct presentation to the endovascular center and 2) patients who were admitted via interhospital transfer to the enrolling hospital. The primary clinical outcome was the modified Rankin score at 90 days. A hypothetical scenario was calculated by comparing door-to-tPA times and adding transfer time to the direct group to calculate a conservative estimate of additional travel time. A total of 984 subjects from 55 different sites were analyzed. The median time from stroke onset to revascularization was 204 minutes in the patients admitted directly to the endovascular center, compared to 312 minutes for patients transferred (P < 0.0001). Clinical outcomes at 90 days were better in the direct group, with 60% achieving mRS 0-2 compared to only 52.5% achieving an equal clinical functional recovery in the transfer group (P = 0.02). In patients who had excellent outcomes with mRS 0-1, this was achieved in 47.4% of directly admitted patients compared to 38.0% of those transferred from another hospital. Mortality did not differ between the two groups (15.1% vs. 13.7%). Using their hypothetical calculations for administration of IV tPA, the researchers calculated that there could be a delay in administering IV thrombolysis of as much as 22 minutes with direct admission, but thrombectomy would still be performed 90 minutes sooner. Investigators concluded that, overall, patient outcomes will be better if patients who have severe ischemic strokes are admitted directly to centers that have endovascular capability.