Regional Strategy for Transfer for Mechanical Thrombectomy

Study Overview
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Brief Summary
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A mono-centre observational study with the aim of compare clinical outcome at 3 month on patients admitted with recent cerebral infarct and intracranial large vessel occlusion in the anterior circulation who are eligible for mechanical thrombectomy in three different position : Patients admitted first in the Comprehensive Stroke Center of Montpellier, those transferred after Proximity Stroke Unit or prehospital bypass for patients with high suspicion of large vessel occlusion.to the Comprehensive Stroke Center of Montpellier

Detailed Description
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Multiple RCT has recently proved the superiority of mechanical thrombectomy compared to the best medical therapy (BMT) on patients with recent cerebral infarct and anterior circulation intracranial large vessel occlusion. In the Occitanie-Est region (ex Languedoc Roussillon), comprising 6 Stroke Unit, only the Comprehensive Stroke Unit of the CHU de Montpellier has a centre of interventional neuroradiology (NRI) that can perform mechanical thrombectomy. Patients suspected of stroke are referred to the nearest SU, then the candidates for thrombectomy, are transferred secondarily to the Stroke Center in Montpellier. Currently, there is no evidence that an initial management in a proximity stroke unit and a secondary transfer for a mechanical thrombectomy is associated with a loss of chance for patients, compared to patients initially treated at the Stroke Center regional reference. The objective of the study is to compare clinical outcome on patients admitted first in the Comprehensive Stroke Center of Montpellier those transferred after Proximity Stroke Unit or directly admitted when high suspicion of large vessel occlusion.

Official Title
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Strategy for Transfer to Emergency Head And Neck (UTEC) of Stroke Alerts With Suspicion of Large Vessel Occlusion for Mechanical Thrombectomy in the Languedoc Roussillon Region

Conditions
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Large Vessel Occlusion, Stroke, Ischemic

Intervention / Treatment
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* Other: Mechanical thrombectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient, admitted to the Emergency Department Head and Neck of the CHU de Montpellier, over 18 years old, without limit of upper age With TIA or cerebral infarction (confirmed by brain imaging (MRI or CT scan), acute (Time of stroke symptoms or discovery of patient ≤ 12 h) With anterior circulation intracranial large vessel occlusion (M1, T or proximal M2), confirmed by arterial imaging (magnetic resonance angiography-MRA- or angioscanner) No objection of the patient or their representative to being included in the cohort Exclusion Criteria: Patient with severe intercurrent pathology impacting the short-term vital prognosis and making follow-up impossible Predictable impossibility of patient follow-up

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Mechanical thrombectomy|Neuroradiological endovascular treatment|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Modified Rankin Score (mRS) | Good functional outcome ( defined by a Modified Rankin Scale of 0-2, 3 months after stroke onset Modified Rankin scale . Range 0 (asymptomatic) to 6 (death) Good outcome : 0 to 2 Disability : 3 to 5 Bad outcome : 5 and 6 | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incidence of mechanical thrombectomy treatment | Safety of medical complication Complications of mechanical thrombectomy : Vessel perforation Intramural Arterial dissection Symptomatic Intracerebral hemorrhage embolization to a new territory | 24 hours | 
| Clinical evolution at 24 hours | NIHSS scale and NIHSS scale variation between the inclusion at 24 hours National Institutes of Health Stroke Scale (NIHSS). Range 0-42. Neurological severity score at the acute phase : Minor stroke : 0 to 5 Moderate stroke 6 to 20 Severe stroke up to 21 | 24 hours | 
| Clinical evolution 7 days | NIHSS scale and NIHSS scale variation between the inclusion at 7 days National Institutes of Health Stroke Scale (NIHSS). Range 0-42. Neurological severity score at the acute phase : Minor stroke : 0 to 5 Moderate stroke 6 to 20 Severe stroke up to 21 | 7 days | 
| Proportion of patients having had mechanical trombectomy (and/or intravenous thrombolysis) amongst patient cohort. | Number of patients having had mechanical trombectomy (and/or intravenous thrombolysis) amongst patient cohort. | 24 hours | 
| Symptomatic Intracerebral Haemorrhage | symptomatic Intracerebral Haemorrhage on cerebral imaging at 24 hours | 24 hours | 
| Arterial Recanalisation with TICI score | Quality of revascularization after mechanical thrombectomy : immediate post-Mechanical-Trombectomy evaluation for patient having had mechanical thrombectomy and at 24 hours for all patient cohort. TICI score (Thrombolysis In Cerebral Infarction grading system) describe the quality of revascularization after mechanical thrombectomy (Grade 0 for no perfusion at 3 for Complete perfusion) | post-act / 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Ischemic stroke, Mechanical Thrombectomy