Predictors of Good Clinical Outcome in Patients with Acute Stroke Undergoing Endovascular Treatment - Results from CERBERUS

Background: Endovascular therapy (EVT) with stent retrievers has been shown to be superior and safe (in the anterior circulation) in comparison to intravenous thrombolysis (IVT) alone or no specific therapy. We compared clinical outcome between patients undergoing EVT admitted directly to comprehensive stroke centers (CSCs) and patients transfer red from primary stroke centers (PSCs) to a CSC. Materials and methods: Demographics, risk factors, and medical history of all consecutive EVT-treated stroke patients in collaborating stroke centers were collected. Patients were divided into three groups: treatment with IVT in a PSC before transfer to a CSC for EVT; treatment with IVT directly in a CSC with subsequent EVT in the same center; no treatment with IVT before EVT. Neurological status using the National Institutes of Health Stroke Scale (NIHSS) on admission and at day 7 and self-sufficiency using the modified Rankin Scale (mRS) at day 90 were assessed. Favorable clinical outcome was defined as an mRS score of 0-2. Follow-up computed tomography or magnetic resonance imaging was done to determine symptomatic intracerebral hemorrhage (SICH). Results: A total of 568 patients (313 males; mean age, 66.1 +/- 13.2 years) were registered from January 2006 to the end of July 2015. Patients in all three groups did not differ in baseline characteristics except for the time to the start of EVT. The average delay of EVT start in patients transfer red from PSC to CSC was 45 min. Subgroups did not differ significantly in SICH prevalence (over all prevalence 5.5%) and favorable clinical outcome (over all 46.7%). Conclusion: The benefit of direct transfer to a CSC merits further investigation. The present study showed that both approaches to stroke patient transport organization in the Czech Republic are comparably efficient and safe.