title: Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke: The Madrid Stroke Network Experience.
abstract: OBJECTIVE
  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.
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.). blanca.fuentes@salud.madrid.org.
authors.forename: Blanca
authors.initials: B
authors.lastname: Fuentes
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: María
authors.initials: M
authors.lastname: Alonso de Leciñana
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Alvaro
authors.initials: A
authors.lastname: Ximénez-Carrillo
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Patricia
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Cruz-Culebras
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Gustavo
authors.initials: G
authors.lastname: Zapata-Wainberg
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ruiz-Ares
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Remedios
authors.initials: R
authors.lastname: Frutos
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Eduardo
authors.initials: E
authors.lastname: Fandiño
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Jose L
authors.initials: JL
authors.lastname: Caniego
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Andrés
authors.initials: A
authors.lastname: Fernández-Prieto
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Jose C
authors.initials: JC
authors.lastname: Méndez
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bárcena
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Begoña
authors.initials: B
authors.lastname: Marín
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Andrés
authors.initials: A
authors.lastname: García-Pastor
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Fernando
authors.initials: F
authors.lastname: Díaz-Otero
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Gil-Núñez
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Jaime
authors.initials: J
authors.lastname: Masjuán
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Jose
authors.initials: J
authors.lastname: Vivancos
authors.affiliation: From the Departments of Neurology and Radiology, Stroke Center, La Paz University Hospital, Autonomous University of Madrid, IdiPAZ Health Research Institute, Madrid, Spain (B.F., P.M.-S., G.R.-A., R.F., A.F.-P., B.M., E.D.-T.); Departments of Neurology and Radiology, Stroke Center, Ramón y Cajal University Hospital, IRYCIS, University of Alcala de Henares, Madrid, Spain (M.A.d.L., A.C.-C., E.F., J.C.M., J.M.); Departments of Neurology and Radiology, Stroke Center, La Princesa University Hospital, Autonomous University of Madrid, Madrid, Spain (A.X.-C., G.Z.-W., J.L.C., E.B., J.V.); and Department of Neurology, Stroke Center, Gregorio Marañón University Hospital, IiSGM Health Research Institute, Complutense University of Madrid, Madrid, Spain (A.G.-P., F.D.-O., A.G.-N.).
authors.forename: Exuperio
authors.initials: E
authors.lastname: Díez-Tejedor
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D018447:Medical Futility; D008875:Middle Aged; D010360:Patient Transfer / Q000379:methods*; D011446:Prospective Studies; D012042:Registries; D013030:Spain / Q000453:epidemiology; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery; D016896:Treatment Outcome
keywords: endovascular treatment; neuroimaging; patient transfer; stroke; stroke networks