Transferring Patients for Bed Availability After Endovascular Thrombectomy Does Not Affect Patient Outcomes

Introduction: Endovascular thrombectomy (EVT) has been shown to improve functional outcomes of patients who suffer from ischemic strokes with large vessel occlusions (LVOs). However, access to EVT can be limited as only thrombectomy-capable stroke centers (TSC) can provide EVT. Current models of stroke care utilize different transport strategies to maximize EVT access, but limiting variables such as bed availability can negatively impact a CSC’s capacity to offer EVT to patients. We aimed to understand the safety and efficacy of interhospital transfers (IHT) for postprocedural care after EVT.

Methods: A single multi-hospital health system retrospective review identified all patients with an anterior circulation LVO after January 2020 who received an IHT after EVT for postprocedural care. Patients were excluded if they were transferred for an escalation in care, such as decompressive hemicraniectomy. Patients who received IHT were matched to patients who were retained after EVT by age, sex, baseline modified Rankin scale (mRS), and baseline National Institutes of Health Stroke Scale (NIHSS). Clinical data including baseline comorbidities, initial stroke management, complications, hospital course, surgical interventions, and functional status upon discharge were reviewed.

Results: 22 patients who had received a transfer after EVT were identified and matched to 22 patients who were retained after EVT. There were no significant differences between the two groups in baseline comorbidities, tPA administration, occlusion location, number of passes, or final recanalization score. No significant differences were identified in ICU length of stay, hospital length of stay, discharge disposition, mRS at day 5/discharge, NIHSS at day 5/discharge, or mRS at 90-days post-discharge. No significant differences were identified in the rate of symptomatic hemorrhage or EVT-related complications including vessel dissection or rupture. No significant differences were identified in the rate of surgical interventions including hemicraniectomy, suboccipital craniectomy, tracheostomy, PEG, or ventriculostomy placement.

Conclusion : Transferring patients to a different hospital for resource management after EVT did not affect patient outcomes in this cohort. CSCs may be able to leverage ICU-capable centers to increase bed capacity and improve EVT access for patients.