Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke: The Madrid Stroke Network Experience.
BACKGROUND AND PURPOSE
The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke and the small number of patients eligible for treatment justify the development of stroke center networks with interhospital patient transfers. However, this approach might result in futile transfers (ie, the transfer of patients who ultimately do not undergo ERT). Our aim was to analyze the frequency of these futile transfers and the reasons for discarding ERT and to identify the possible associated factors.


METHODS
We analyzed an observational prospective ERT registry from a stroke collaboration ERT network consisting of 3 hospitals. There were interhospital transfers from the first attending hospital to the on-call ERT center for the patients for whom this therapy was indicated, either primarily or after intravenous thrombolysis (drip and shift).


RESULTS
The ERT protocol was activated for 199 patients, 129 of whom underwent ERT (64.8%). A total of 120 (60.3%) patients required a hospital transfer, 50 of whom (41%) ultimately did not undergo ERT. There were no differences in their baseline characteristics, the times from stroke onset, or in the delays in interhospital transfers between the transferred patients who were treated and those who were not treated. The main reasons for rejecting ERT after the interhospital transfer were clinical improvement/arterial recanalization (48%) and neuroimaging criteria (32%).


CONCLUSIONS
Forty-one percent of the ERT transfers were futile, but none of the baseline patient characteristics predicted this result. Futility could be reduced if repetition of unnecessary diagnostic tests was avoided.
['Fuentes|Blanca|B|', 'Alonso de Leciñana|María|M|', 'Ximénez-Carrillo|Alvaro|A|', 'Martínez-Sánchez|Patricia|P|', 'Cruz-Culebras|Antonio|A|', 'Zapata-Wainberg|Gustavo|G|', 'Ruiz-Ares|Gerardo|G|', 'Frutos|Remedios|R|', 'Fandiño|Eduardo|E|', 'Caniego|Jose L|JL|', 'Fernández-Prieto|Andrés|A|', 'Méndez|Jose C|JC|', 'Bárcena|Eduardo|E|', 'Marín|Begoña|B|', 'García-Pastor|Andrés|A|', 'Díaz-Otero|Fernando|F|', 'Gil-Núñez|Antonio|A|', 'Masjuán|Jaime|J|', 'Vivancos|Jose|J|', 'Díez-Tejedor|Exuperio|E|', '|||']
D000368:Aged D002545:Brain Ischemia D057510:Endovascular Procedures D005260:Female D006801:Humans D008297:Male D018447:Medical Futility D008875:Middle Aged D010360:Patient Transfer D011446:Prospective Studies D012042:Registries D013030:Spain D020521:Stroke D016896:Treatment Outcome
endovascular treatment stroke stroke networks patient transfer neuroimaging