Influence of interhospital transfer on endovascular thrombectomy outcome in acute ischemic stroke patients: an analysis of the TREAT-AIS registry.
Journal
Frontiers in Neurology
Journal Volume
17
Start Page
Article Number : 1743928
ISSN
1664-2295
Date Issued
2026
Author(s)
Wang, Ching-Yi
Chen, Chi-Jen
Hsieh, Yi-Chen
Lin, Wey-Yil
Tang, Sung-Chun
Chen, Chih-Hao
Lin, Chun-Jen
Lin, Kuan-Hung
Sung, Pi-Shan
Tang, Chih-Wei
Chu, Hai-Jui
Fu, Chuan-Hsiu
Chou, Chao-Liang
Wei, Cheng-Yu
Yen, Shang-Yih
Chen, Po-Lin
Yeh, Hsu-Ling
Sung, Sheng-Feng
Lin, Ching-Huang
Lee, Meng
Lee, I-Hui
Chen, Yu-Wei
Chan, Lung
Lien, Li-Ming
Chiou, Hung-Yi
Lee, Jiunn-Tay
Jeng, Jiann-Shing
Abstract
Background: The outcome of patients undergoing endovascular thrombectomy (EVT) for large vessel occlusion in a comprehensive stroke center (CSC) is affected by the onset-to-treatment time. Whether the pathway to CSC arrival (direct vs. interhospital transfer) is thus associated with EVT outcomes among such patients is unknown. Methods: Using the Taiwan Registry of Endovascular Thrombectomy for AIS registry, patients ≥20 years of age and receiving EVT for AIS within 24 h of onset between January 2019 and December 2022 were included. Patients were categorized according to CSC arrival pathway into direct arrival and transfer groups. The primary outcome was 3-month functional independence, defined as a modified Rankin Scale (mRS) of 0–2. Results: Of the1830 patients included, 79% arrived at a CSC directly and 21% via transfer. More patients in the direct arrival than the transfer group achieved a 3-month mRS of 0–2. A significant interaction was found between onset-to-puncture (OTP) time and arrival pathway for achieving 3-month mRS 0–2 (p interaction = 0.017). Arrival by transfer was associated with reduced odds of achieving mRS 0–2 when OTP time was < 6 h (aOR, 0.55), but with increased odds when OTP was ≥6 h (aOR, 1.95). Conclusions: Direct arrival was associated with improved outcomes if OTP < 6 h. Patients who arrive via transfer may still benefit substantially from EVT during the later treatment window. Further study is warranted to examine the predictors of favorable post-EVT outcomes within a 24-h window to facilitate timely treatment.
Subjects
direct transport
endovascular thrombectomy
functional outcome
inter-hospital transfer
ischemic stroke
onset-to-puncture time
Publisher
Frontiers Media SA
Type
journal article