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The Role of Vascular Imaging atReferral Centers in the Drip and Ship Paradigm

2021; Elsevier BV; Volume: 31; Issue: 1 Linguagem: Inglês

10.1016/j.jstrokecerebrovasdis.2021.106209

1532-8511

Alan Flores, Laia Seró, Manuel Gómez‐Choco, Xavier Ustrell, Anna Pellisé, Jaume Viñas, Paula Rodríguez, Angela Monterde, Gislaine Castilho, Marta Rubiera, Sergi Amaro, Maria Àngels Font Padrós, Pedro Cardona, Joan Martí‐Fàbregas, Carlos A. Molina, Joaquı́n Serena, Francesc Xavier Jiménez-Fàbrega, Francisco Purroy, José Zaragoza‐Brunet, Dolores Cocho, Ernest Palomeras, Jurek Kuprinski, Natalia Más, María Hernández‐Pérez, Eduard Sanjurjo, Dolors Carrión, Xavier Costa, Miquel Barceló, Jordi Monedero, Esther Catena, Maria Rybyeba, Glòria Díaz, Natàlia Pérez de la Ossa, Marc Ribó,

Cerebrovascular and Carotid Artery Diseases

In drip-and-ship protocols, non-invasive vascular imaging (NIVI) at Referral Centers (RC), although recommended, is not consistently performed and its value is uncertain. We evaluated the role of NIVI at RC, comparing patients with (VI+) and without (VI-) vascular imaging in several outcomes.Observational, multicenter study from a prospective government-mandated population-based registry of code stroke patients. We selected acute ischemic stroke patients, initially assessed at RC from January-2016 to June-2020. We compared and analyzed the rates of patients transferred to a Comprehensive Stroke Center (CSC) for Endovascular Treatment (EVT), rates of EVT and workflow times between VI+ and VI- patients.From 5128 ischemic code stroke patients admitted at RC; 3067 (59.8%) were VI+, 1822 (35.5%) were secondarily transferred to a CSC and 600 (11.7%) received EVT. Among all patients with severe stroke (NIHSS ≥16) at RC, a multivariate analysis showed that lower age, thrombolytic treatment, and VI+ (OR:1.479, CI95%: 1.117-1.960, p=0.006) were independent factors associated to EVT. The rate of secondary transfer to a CSC was lower in VI+ group (24.6% vs. 51.6%, p<0.001). Among transferred patients, EVT was more frequent in VI+ than VI- (48.6% vs. 21.7%, p<0.001). Interval times as door-in door-out (median-minutes 83.5 vs. 82, p= 0.13) and RC-Door to puncture (median-minutes 189 vs. 178, p= 0.47) did not show differences between both groups.In the present study, NIVI at RC improves selection for EVT, and is associated with receiving EVT in severe stroke patients. Time-metrics related to drip-and-ship model were not affected by NIVI.