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Abstract 82: The Association of Transfer Status and Time on Clinical and Imaging Outcomes in Large Core Strokes: A SELECT2 Subanlaysis
Abstract   Peer reviewed

Abstract 82: The Association of Transfer Status and Time on Clinical and Imaging Outcomes in Large Core Strokes: A SELECT2 Subanlaysis

Amrou Sarraj, Michael G Abraham, Michael Chen, Scott E Kasner, Santiago Ortega-Gutierrez, Muhammad S Hussain, Deep Pujara, Faris Shaker, Leonid Churilov, Sophia Sundararajan, …
Stroke (1970), Vol.55(Suppl_1)
02/2024
DOI: 10.1161/str.55.suppl_1.82

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Abstract

Abstract only Background: Patients with large core strokes have poor clinical outcomes and are frequently not transferred to endovascular thrombectomy (EVT)-capable centers for EVT. We analyzed the association of transfer status and time on neuroimaging changes, clinical outcomes and EVT treatment effect in SELECT2. Methods: Patients enrolled in the SELECT-2 trial were stratified based on transfer status. CT ASPECTS at outside hospital and EVT center were collected if available. Treatment effect was compared by transfer status as well as in transferred patients with outside ASPECTS ≤5. The association of ASPECTS loss during transfer was also quantified. The primary outcome was the distribution of modified Rankin Scale score at 90-day follow-up. Results: Of 352 enrolled patients, 211 (60%) were transferred to EVT capable center and 108(51%) received EVT. 141 presented directly and 72 (51%) received EVT. The median transfer time was 185 (140-234) minutes. Median ASPECTS decreased from outside hospital [5(4-7)] to EVT center [4 (3-5)] with ASPECTS decay rate at 0.31 (0-0.84) points/hour of transfer time, with 50/120 (42%) experienced ASPECTS loss ≥2. Thrombectomy treatment effect was preserved in both directly presenting patients [aGenOR: 2.01 (1.42-2.86)] as well as transferred patients [aGenOR: 1.50 (1.11-2.03)] without significant heterogeneity (P-int=0.14). EVT also demonstrated numerically better functional outcomes in transferred patients with outside ASPECTS of ≤5 (n=65, 35 EVT, aGenOR: 1.77 (0.97-3.23), p=0.068). ASPECTS loss was associated with worse clinical outcomes in EVT [aGenOR: 0.81 (0.71-0.83) per ASPECTS point loss] but not in MM: [aGenOR: 0.89 (0.73-1.08) per ASPECTS point loss]. Conclusion: In large core patients, transfer time was associated with ASPECTS decay, resulting in worse outcomes with EVT. Transferred patients however still benefited from EVT, with a trend towards better outcomes in patients with low ASPECTS at outside hospitals. These findings may substantially impact stroke care infrastructure, emphasizing the need for rapid identification of patients suitable for transfer and expedited transport. Clinicaltrials.gov registration: NCT03876457

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