Comparison of interhospital transfer and direct presentation for mechanical thrombectomy in the treatment of acute ischemic stroke in a major US metropolitan area
- Journal
- Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association (Q1)
- Published
- 16 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Elsa A Olson, Christina A Rogers, Manhal M Siddiqi, Jacob S Riccio, Bichun Ouyang, Sarah Song, et al.
- PMID
- 42748986
- DOI
- 10.1016/j.jstrokecerebrovasdis.2026.108750
Why clinicians should know about it
- Picked for Neurology (clinical) (paper of the day, 18 September 2026): Transfer vs direct thrombectomy outcomes
Abstract
BACKGROUND AND OBJECTIVES: Timely medical and procedural intervention has been a tenet of the management of patients with acute ischemic stroke (AIS). Treatment at a comprehensive, high-volume center consistently has been associated with improved clinical outcomes. At times, these principles of management may be in conflict with each other when patients do not present directly to a comprehensive, experienced center. METHODS: We retrospectively analyzed the data from 193 patients with AIS who underwent mechanical thrombectomy (MT) at a single center, academic comprehensive stroke center, comparing clinical and radiographic data for patients who were transferred (157 (81.3%)) to those who presented directly to our center (36 (18.7%)). RESULTS: Patients who presented directly had shorter last known well (LKW)-to-arrival and LKW-to-puncture time compared to those who were transferred (median 1.83 hours vs 6.17 hours (p < 0.0001) and median 4.12 hours vs 6.67 hours (p = 0.001), respectively). Patients presenting directly and those who were transferred had similar change in NIHSS from initial NIHSS to discharge NIHSS (median -7.5 vs -7 (p = 54), respectively), similar discharge NIHSS (median 3.5 vs 5 (p = 0.24), respectively), similar rates of mRS 0-2 (38.9% vs 31.2% (p = 0.38), respectively) and similar rates of TICI 2b-3 (86.1% vs 88.4% (p = 0.78), respectively). CONCLUSIONS: Despite longer LKW-to-arrival and LKW-to-puncture times, transferred AIS patients had similar clinical and radiographic outcomes following MT compared to those presenting directly to our center. These findings suggest that, within this cohort, the time needed for transfer to an experienced center was not associated with worse outcomes compared to direct presentation. Whether earlier treatment at a lower-volume center would have yielded comparable or superior outcomes cannot be determined from this study.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.