Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke
2015; Lippincott Williams & Wilkins; Volume: 46; Issue: 8 Linguagem: Inglês
10.1161/strokeaha.115.009282
ISSN1524-4628
AutoresBlanca Fuentes, María Alonso de Leciñana, Álvaro Ximénez‐Carrillo, Patricia Martínez‐Sánchez, Antonio Culebras, Gustavo Zapata-Wainberg, Gerardo Ruiz‐Ares, R. Frutos, Eduardo Fandiño, José Luis Caniego, A. Prieto, José Carlos Méndez, Eduardo Bárcena, Begoña Marín, Á. García Pastor, Fernando Díaz‐Otero, Antonio Gil-Núñez, Jaime Masjuán, José Vivancos, Exuperio Díez–Tejedor,
Tópico(s)Peripheral Artery Disease Management
ResumoBackground and Purpose— The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke and the small number of patients eligible for treatment justify the development of stroke center networks with interhospital patient transfers. However, this approach might result in futile transfers (ie, the transfer of patients who ultimately do not undergo ERT). Our aim was to analyze the frequency of these futile transfers and the reasons for discarding ERT and to identify the possible associated factors. Methods— We analyzed an observational prospective ERT registry from a stroke collaboration ERT network consisting of 3 hospitals. There were interhospital transfers from the first attending hospital to the on-call ERT center for the patients for whom this therapy was indicated, either primarily or after intravenous thrombolysis (drip and shift). Results— The ERT protocol was activated for 199 patients, 129 of whom underwent ERT (64.8%). A total of 120 (60.3%) patients required a hospital transfer, 50 of whom (41%) ultimately did not undergo ERT. There were no differences in their baseline characteristics, the times from stroke onset, or in the delays in interhospital transfers between the transferred patients who were treated and those who were not treated. The main reasons for rejecting ERT after the interhospital transfer were clinical improvement/arterial recanalization (48%) and neuroimaging criteria (32%). Conclusions— Forty-one percent of the ERT transfers were futile, but none of the baseline patient characteristics predicted this result. Futility could be reduced if repetition of unnecessary diagnostic tests was avoided.
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