Workflows and Outcomes in Patients With Suspected Large Vessel Occlusion Stroke Triaged in Urban and Nonurban Areas
Authors: Garcia-Tornel Alvaro , Millan Monica , Rubiera Marta , Bustamante Alejandro , Requena Manuel , Dorado Laura , Olivé-Gadea Marta , Jiménez Xavier , Soto Angels , Querol Marisol , Hernández-Pérez Maria , Gomis Meritxell , Cardona Pere , Urra Xabier , Purroy Francesc , Silva Yolanda , Ustrell Xavier , Esteve Patricia , Salvat-Plana Mercè , Gallofré Miquel , Molina Carlos , Dávalos Antoni , Jovin Tudor , Abilleira Sonia , Ribo Marc , Pérez de la Ossa Natalia , Jacobi Marc Ribó , Sanjuan Estela , Santana Katherine , Rodríguez Noelia , Pagola Jorge , Rodriguez-Luna David , Maisterra Olga , Santamarina Estevo , Muchada Marian , Juega Jesús , Boned Sandra , Franco Antonio Palasi , García -Tornel Álvaro , Deck Matías , Sala Victoria , Muñoz Lucía , Millán Mónica , López-Cancio Elena , Hernández-Pérez María , Ciurans Jordi , Samaniego Daniela , Canento Tamara , Martin Lorena , Planas Anna , Broto Joaquin , Sorrentino Agustín , Paré Martí , Zhu Nuole , Garrido Alicia , Grau Laia , Crespo Ane Miren , Presas Silvia , Almendrote Miriam , Ramos Alba , Lucente Giuseppe , Ispierto Lourdes , Lozano Manuel , Becerra Juan Luis , Jiménez Marta , Rolán Dolores Vilas , Guanyabens Nicolas , Sanchez-Ojanguren Josep , Martínez-Piñeiro Alicia , Forcén Sara , Gea Mireia , Álvarez Marta , Ramos Anna , Lizarbe Manuel Domínguez , Guerra Sara, Rubio , Bragado Irene , Arbex Andrea , Rodríguez Luis , Portela Pere Cardona , García Helena Quesada , Rodríguez Blanca Lara , Cayuela Nuria , Miró Julia , Marzal Clara , Paipa Andrés , Campoy Sergio , Núñez Ana , Arroyo Pablo , Besora Sarah , Adell Vanessa , Campdelacreu Jaume , Martí Montse Alemany , González Belén , Vila Laura Bau , Crespo Marta Fiter , Berbel Anna , Urbaneja Ma. Cristina Villaescusa , Guillen Núria , Vidal Nuria , Vérez Santamaria Patricia Valentina , Navarro Diego Herrero , Simó Marta , Falip Mercedes , Matas Elisabeth , Ochoa Neus Mongay , Gifreu Ariadna , Muñoz Albert , Romero Lucía , Portell Eduard , Perez Guillermo Hernández , Esteve F. Ruiz , Teixidor Silvia , Talavera Augusto Salazar , Gómez Roser , Nuin Xabier Urra , Vargas Martha , Chamorro Ángel , Amaro Sergio , Llull Laura , Renú Arturo , Rudilosso Salvatore , del Valle Raquel Sánchez , Ariño Helena , Solà Nuria , la Puma Delón , Gil Francisco , Gómez Juan Bernardo , Matos Nuria , Falgàs Neus , Borrego Sergi , Sánchez Almudena , Balasa Mircea , Montejo Carmen , Guasp Mar , Reyes David , Cervilla Pablo Sánchez , Contador Jose Miguel , Vera Monge Victor Augusto , Ramos Oscar , Rodríguez Alejandro , Campello Ana Rodríguez , Ballester Gemma Romeral , Trujillano Mireia Llop , Steinhauer Eva Giralt , Godia Elisa Cuadrado , Ois Santiago Angel Javier , Conde Jordi Jimenez , Fábregas Joan Martí , Guisado Daniel , Prats Luís , Camps Pol , Delgado Raquel , Domeño Alejandro Martínez , Marín Rebeca , Cànovas David , Estela Jordi , Ros Marta , Aranceta Sonsoles , Espinosa Jordi , Rubio Marta , Lafuente Cristina , Barrachina Oriol , Anguita Alicia , Reverter Anna , García Carmen , Sansa Gemma , Hervas Mariona , Crosas Monica , Delgado Tania , Krupinski Jerzy , Folch Sonia Huertas , Gamito Gemma Muñoz , Alvarez Josep Trenado , Subirana Teresa , Molina Jessica , Besora Sarah , Romero Laura Comes , Valls Gemma Guardia , Jover Miriam , Sotova Javier Joaquín , García Sánchez Sonia Mª , Valenzuela (intensivista) Sebastian , Gómez-Choco Manuel , Mengual Juan José , Font M. 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Torrano , Esparza Torres , Uku Florenc , Blanco Vazquez , De la Paz Vazquez , Gil Vazquez , Gonzalez Vazquez , Meler Vidal , Cots Vilalta , Jimenez Vilches , Jose Maria , Fernandez Visser , Gavin Viu , Vives Vives , Jimenez Carmona , Jose Francisco , Vilches Galobardes , Gomez Gonzalez , Manzanera Jodar , Cortes Marimon , Orive Marrodan , Bosch Martin , Jose Maria , Lopez Martorell , Roca Millares , Jesus M , Guri Miralles , Hernandez Muliterno , Oliva Muñoz , Pujol Pons , Conde Postius , Arruñada Prieto , Antonio Jose , Mathé Quintana , Mata Rosell , Alvarez Aguirre , Alvarez Alvarin , Flores Arrufat , Pago Bañuelos , Andreu Burnat , Vilar Campo , Hidalgo Cardus , Gil Castello , Gloria Maria , Montsesinos Castrillo , Estopà Català , Garces Clave , Sanroma Comes , Sequi Descalzo , Ricol Errando , Campillo Escudero , del Mar Maria , Alvarez Fernandez , Gomez Fernandez , Perez Fernandez , Espinosa Franch , Graells Freixes , Plaza Garcia , Gallego Garcia-Marron , Simancas Hernandez , Covas Homar , Royo Huerta , Armas Jaraba , Ramos Jimenez , Canela Lopez , Angeles M , Lopez Lopez , Oganissian Lopez , Romero Madrona , Rosa M , Millan Martinez , Morón Martínez , Encinas Merchan , Fornieles Morell , Jimenez Moreno , Rico Muñoz , Rodriguez Navarro , Ibañez Nogales , Maria Rita , Viera Novillo , Torrabadella Parella , Alba Mari , Villar Pera , Montserrat Carla , Carbonell Puertas , Miralles Rabella , Trilles Ramis , Ortiz Ribera , Fuertes Rodriguez , Gonzalez Sanchez , Perez Sastre , Perez Segura , Borrega Soro , Garcia Soto , Angeles Maria , Fores Tapia , Bernad Tellez , Alvarez Trenado , Moreda Español , Martin Felix , Perez Herrero , Manzanera Jodar , Fuster Lanau , Gomariz Lopez , Orive Marrodan , Bosch Martin , Jose Maria , Guri Miralles , Oliva Muñoz , Lozano Pardo , Pujol Pons , Altimiras Quintana , Lopez Ventosa , Damian Almodovar , Colino Alvarez , Monterroso Alvarez , Comas Arambudo , Garzon Boullon , Capella Burgos , Garcia Campuzano , Del Mar Maria , Olivas Capdevila , Fernandez Carcelen , Solà Caro , Marti Carre , Isabel Clara , Bacaicoa Carretero , Gil Castello , Gloria Maria , Montsesinos Castrillo , Calderon Cazorla , Osuna Chacon , Planas Cortes , Olio Cortit , Estany Delhomme , Carasso Duran , Javier Pablo , Campillo Escudero , del Mar Maria , Martinez Fructuos , Lopez Garcia , Luis Pascual , Plaza Garcia , Amill Vallve Genis , Arroyo Gomez , Girbau Gomez , Muñoz Gonzalez , Ventura Hernaez , Covas Homar , Gimenez Lavernia , Rojo Martin , Medina Martínez , Millan Martinez , Barrera Mayol , Pi Mercader , Dalmau Merino , Campodarbe Miguel , Pastalle Montserrat Puig , de la Cruz Morales , Fornieles Morell , Sanchez Moreno , Javier Francisco , Reig Pallares , Torrabadella Parella , Mari Alba , Barrameda Penela , Ajenjo Prieto , Benavente Rebollar , Pareja Rodriguez , Piñar Rodríguez , Francisco Javier , Tello Rodriguez , Pereda Romero , Saborido Sainz , Martin Santacana , Martinez Santos , Chavez Sierra , Testa Toledo , Figueras Tomàs , Garcia Torres , José Pedro , Torres Turbau , Domenech Vicente , Esteo Villena , Pertegaz Vives , Gonzalez Baena , Pont Bagaria , Sanchez Beltran , Alarcon Bonet , Ballescà Borch , Clanchet Buhils , Garcia Closa , Carril Colomina , Sanchez Cristina Fernandez , Edurne Judith Fernandez Toledo , Rodriguez Espases , Resa Espert , Xavier F , Sol Fernández , Lugo Gonzalez , Llesera Gracia , Lendinez Herrada , Liesa Juliench , Alicia Sandra , Ortega Lopez , Yuste Lopez , Villanueva Lozano , Soto Lucia Sola , Castellano Madrid , Cano Megias , Jesus Daniel , Ponce Montasell , Sospedra Montesinos , Martinez Moya , Herrera Muñoz , Isabel M , Fernandez Ocaña , Jose Maria , Bernal Palau , Sole Perez , Carbonell Ramon , Lop Ribas , López Rubio , Lopez Rueda , Castaño Sabat , Lara Sabata , Ramírez Salmerón , Gornals Sebastia , Creus Serra , Dalmau Serrano , Mainero Sumasi , Gabriel Gonzalo , Masa Torello , Primo Valencia , Viñuales Muñoz Ana Maria , Roig Josep , Hidalgo. Verònica 
Published: October 2022

Background:

We aim to compare the outcome of patients from urban areas, where the referral center is able to perform thrombectomy, with patients from nonurban areas enrolled in the RACECAT trial (Direct Transfer to an Endovascular Center Compared to Transfer to the Closest Stroke Center in Acute Stroke Patients With Suspected Large Vessel Occlusion).

Methods:

Patients with suspected large vessel occlusion stroke, as evaluated by a Rapid Arterial Occlusion Evaluation score of ≥5, from urban catchment areas of thrombectomy-capable centers during RACECAT trial enrollment period were included in the Stroke Code Registry of Catalonia. Primary outcome was disability at 90 days, as assessed by the shift analysis on the modified Rankin Scale score, in patients with an ischemic stroke. Secondary outcomes included mortality at 90 days, rate of thrombolysis and thrombectomy, time from onset to thrombolysis, and thrombectomy initiation. Propensity score matching was used to assemble a cohort of patients with similar characteristics.

Results:

The analysis included 1369 patients from nonurban areas and 2502 patients from urban areas. We matched 920 patients with an ischemic stroke from urban areas and nonurban areas based on their propensity scores. Patients with ischemic stroke from nonurban areas had higher degrees of disability at 90 days (median [interquartle range] modified Rankin Scale score, 3 [2–5] versus 3 [1–5], common odds ratio, 1.25 [95% CI, 1.06–1.48]); the observed average effect was only significant in patients with large vessel stroke (common odds ratio, 1.36 [95% CI, 1.08–1.65]). Mortality rate was similar between groups(odds ratio, 1.02 [95% CI, 0.81–1.28]). Patients from nonurban areas had higher odds of receiving thrombolysis (odds ratio, 1.36 [95% CI, 1.16–1.67]), lower odds of receiving thrombectomy(odds ratio, 0.61 [95% CI, 0.51–0.75]), and longer time from stroke onset to thrombolysis (mean difference 38 minutes [95% CI, 25–52]) and thrombectomy(mean difference 66 minutes [95% CI, 37–95]).

Conclusions:

In Catalonia, Spain, patients with large vessel occlusion stroke triaged in nonurban areas had worse neurological outcomes than patients from urban areas, where the referral center was able to perform thrombectomy. Interventions aimed at improving organizational practices and the development of thrombectomy capabilities in centers located in remote areas should be pursued.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02795962.