Direct Admission Versus Secondary Transfer for Patients Treated with Mechanical Thrombectomy in Our Comprehensive Stroke Centre - Has Our Relocation Been Justified?

ABSTRACT

Background and Aims: Mechanical thrombectomy can only be performed in comprehensive stroke centres (CSC) which provide onsite interventional radiology and neurosurgical services. The benefits of direct admission to a CSC versus secondary transfer following initial admission to a stroke unit without MT service are heavily contested. Nottingham University Hospitals provides the East Midlands' Mechanical Thrombectomy (MT) service in the United Kingdom. With an aim to reduce the number of transfers for patients eligible for MT within the region, we relocated our stroke services from Nottingham City Hospital (NCH) to Queens' Medical Centre (QMC), a major trauma centre with on-site interventional services in July 2020. Method(s) We compared timings of stroke assessment and outcomes for consecutive patients transferred from NCH to those who were directly admitted to QMC after the change in our service model. Result(s) 101 patients admitted from Nottingham underwent MT between January 2019 and January 2022. For patients transferred (n=48) and patients directly admitted (n=53) respectively average time from CT scan to groin puncture were 163 and 151 minutes;reperfusion rates (TICI>2a) were 100% and 96%. The median modified Rankin Score on discharge were 3.5 and 3.6 respectively. Conclusion(s) Although shorter imaging-to-groin puncture time was demonstrated post-relocation, comparable functional outcomes were seen between patients transferred and directly admitted to our CSC. This could be attributed to an increased time window of MT eligibility from 6 to 24 hours post symptom onset after our relocation. Further studies are required to establish its effects and explore the impacts of the COVID-19 pandemic on our stroke service.