title: Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy.
abstract: BACKGROUND
  After thrombectomy has shown to be effective in acute stroke patients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated.
  
  
  OBJECTIVE
  We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit.
  
  
  METHODS
  Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients.
  
  
  RESULTS
  In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0-2, 44.0% versus 35.7%, p = 0.08).
  
  
  CONCLUSIONS
  Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in stroke patients eligible for thrombectomy after initial brain imaging.
authors.affiliation: Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Str. 21, 45131 Essen, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Weber
authors.affiliation: Department of Neurology, Klinikum Dortmund, Germany.
authors.forename: Gernot
authors.initials: G
authors.lastname: Reimann
authors.affiliation: Department of Neurology, University Hospital of Duisburg-Essen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Weimar
authors.affiliation: Department of Neurology, University Hospital of Duisburg-Essen, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Winkler
authors.affiliation: Institute of Epidemiology and Social Medicine, University of Münster, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Berger
authors.affiliation: Department of Radiology and Neuroradiology, Alfried Krupp Krankenhaus Essen, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Nordmeyer
authors.affiliation: Department of Neurology, Alfried Krupp Krankenhaus Essen, Germany.
authors.forename: Jeffrie
authors.initials: J
authors.lastname: Hadisurya
authors.affiliation: Department of Radiology and Neuroradiology, Klinikum Duisburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Brassel
authors.affiliation: Department of Neurology, Klinikum Bergmannsheil Bochum, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Kitzrow
authors.affiliation: Department of Neurology, St Josef-Hospital Bochum, Germany.
authors.forename: Christos
authors.initials: C
authors.lastname: Krogias
authors.affiliation: Neuroradiology, Klinikum Vest Recklinghausen and Knappschaftskrankenhaus Bochum, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Weber
authors.affiliation: Department of Neurology, St Josef Krankenhaus Moers, Germany.
authors.forename: Elmar W
authors.initials: EW
authors.lastname: Busch
authors.affiliation: Department of Neurology, Knappschaftskrankenhaus Bochum, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Eyding
keywords: functional outcome; ischemic stroke; mortality; periprocedural times; referral status; thrombectomy