Effect of Direct Transportation to Thrombectomy-Capable Center vs Local Stroke Center on Neurological Outcomes in Patients With Suspected Large-Vessel Occlusion Stroke in Nonurban Areas
Authors: Natalia Pérez de la Ossa, Sònia Abilleira, Tudor G. Jovin, Álvaro García-Tornel, Xavier Jimenez, Xabier Urra, Pere Cardona, Dolores Cocho, Francisco Purroy, Joaquin Serena, Luis San Román Manzanera, Rosa Maria Vivanco-Hidalgo, Mercè Salvat-Plana, Angel Chamorro, Miquel Gallofré, Carlos A. Molina, Erik Cobo, Antoni Davalos, Marc Ribo, Jane Abella, Sheila Abrio, Teresa Acera, Ada Aguilar, Sonia Aguirre, Laura Alastrue, Consuelo Almodovar, Marne Cristina Alonso, Angels Aloy, Miriam Alvarez, Miguel Alvarez, Jeannette Alvarez, Celia Alvarin, Maria Vanessa Ameller, Estefania Remedios Andujar, Anna Arambudo, Villagrasa Vilella Ares, Lorena Arrufat, Silvia Auladell, Izaskun Azcarate, Vanessa Aznar, Andres Baena, Marc Bagaria, Joan Bañuelos, Andreu Barnés, Nuria Basany, Cristina Beltran, Sergio Benavent, Silvia Biesot, Roser Blanch, Ariadna Boluda, Victor Bonet, Isabel Bonilla, Gemma Borch, Raquel Boullon, Nuria Bru, Stella Brugues, Estel Buhils, Antonio Burgos, Laia Burnat, Salvador Caballero, Jordi Calafell, Miriam Calvet, Arnau Calvo, Francisco Campo, Olga Campos, Iren Camps, Maria Del Mar Campuzano, Bresme Nuria Cano, Montserrat Capdevila, Antonio Carballo, Daniel Carcelen, Jaume Cardus, Francisco Jose Carmona, Marc Caro, Clara Isabel Carre, Alexander Carretero, Gemma Casajuana, Teresa Casasas, Cristina Castanedo, Maria Gloria Castello, Paramio Castillo, Gonzalo Castrillo, Rosa Maria Castro, M Elena Castro, Xavier Català, Monica Catells, Dolors Catena, Sergio Cazorla, Sandra Cerdeña, Alexandre Chacon, Sunyer Claustre, Enric Clave, Alejandro Closa, Esther Colomina, Montserrat Comes, Loste Cora, Estefani Corrales, Lidia Cortes, Rita Cortit, Pere Lluis Cregut, Nuria Daroca, Carles Delhomme, Anna Delofeu, Carlos Descalzo, Anna Deulofeu, Maneiro Andrea Lucia Diaz, Carmen Diaz, Herrero Navarro Diego, Cucurell Navarro Diego-Javier, Vilas Rolán Dolores, Espinosa Vivas Dolores, Palau M Carme Domenech, Pablo Javier Duran, Marquez Laura Duran, Martin Pau Escoda, Juan Antonio Escorcia, Maria del Mar Escudero, Jaime Español, Agusti Español, Rodriguez Roger Espases, Resa F Xavier Espert, Tio Vilamala Ester, Casanovas David Esteve, Sanjuan Joan Pere Fabregat, Perez Patricia Fernandez, Perez Daniel Fernandez, Gomez Carlos Fernandez, Alvarez Joaquin Fernandez, Sol Mireia Fernández, Quintero Sergi Ferre, Yolanda Ferreres, Casanova Sylvia Figueras, Escobar Sergio Flores, Anna Fontcuberta, Ana Fontquerni, Joan Antoni Forés, Maria Luisa Fortes, Africa Fortes, Espinosa Laura Franch, Romero Maria Teresa Franco, Quesada Sara Maria Franco, Graells Cristina Freixes, Francisco Rut Gallego, Vilches Agusti Galobardes, De Lacanal Carles Galup, Gala Alicia Gamiz, Tortajada Georgina Garcia, Rodriguez Marina Garcia, Plaza Marta Garcia, Lopez Pascual Luis Garcia, Castañeda Laura Garcia, Gallego Ainhoa Garcia-Marron, Faure Helena Gil, Herrera Juan Carlos Gomez, Girbau Xavier Gomez, Arroyo Manuela Gomez, Muñoz Carlos Gonzalez, Lugo Jordi Gonzalez, Lopez Flor Gonzalez, Ricardo Gonzalez, Marta Gonzalez, Gomez Albert Gonzalez, Fernandez Beatriz Gonzalez, Llesera Daniel Gracia, Gallego Azahara del Mar Grajera, Obeso Maria Gual, Blanco Marta Guerrero, Roca Susana Guillemas, Gimenez Cristina Havernia, Ventura Elena Hernaez, Simancas Rafael Hernandez, Sebastia Gemma Hernandez, Luque Sar Hernandez, Lendinez Jorge Herrada, Perez Luis Herrero, Prades Sergio Hijazo, Covas Dolça Homar, Pérez Honey, Alvarez Lluis Hostench, Royo Marta Huerta, Barcelo Paula Ibañez, Alessandro Inio, Cruz Marta Izquiero, Armas Sonia Jaraba, Ramos Pedro Jimenez, Delgado Sonia Jimenez, Laura Jodar, Gimenez Jordi Juárez, Gil Vázquez Junior, Fuster Pedro Lanau, Gasco Gustavo Laparra, Moreales Anna Lara, Arroyo Dulcenombre de Jesus Las, Medina Maria Lourdes Lasaosa, Sanz Pilar Laserreta, Cava Aida Lazaro, Vidal Monica Llambrich, Yuste Samuel Lopez, Ramirez Cristian Lopez, Ortega Joel Lopez, Oganissian Aleix Lopez, Lopez Anabel Lopez, Lopez Alejandro Lopez, Gomariz Alfonso Lopez, Diaz Enric Lopez, Canela M Angeles Lopez, Romero Pedro López, Maturana Laura López, Villanueva Marta Lozano, Nicola Alexia Lujan, Diaz Jose Antonio Madrid, Romero M  Rosa Madrona, Gay M Angel Mallafre, Cortes Jose Marimon, Orive Felix Marrodan, Rovira Rafael Marti, Clemente Albert Marti, Rojo Rafael Martin, Bosch Maria Jose Martin, Quesada Martinez, Millan Daniel Martinez, Gonzalez Paula Martinez, Gamez David Martinez, Castaño David Natanael Martinez, Morón Marta Martínez, Medina Marta Martínez, Lopez Manuel Martorell, Fusté Mireia Conillera M Marzà, Barrera Sergi Mayol, Cano Daniel Jesus Megias, Lasheras Marta Melendo, Pi Xavier Mercader, Dalmau Isabel Merino, Mestre Jordi Miralles, Guri Carles Miralles, Balasa Mircea, Corral Jordi Monllao, Ponce Arich Montasell, Sospedra Susana Montesinos, del Carpio Montgomery, Vives M Angela Mora, Ponce Christian Morales, de la Cruz Raquel Morales, Alvarez Jorge Arnulfo Morales, Fornieles Olga Morell, Sanchez Francisco Javier Moreno, Jimenez Sandra Moreno, Blanco Arantxa Moreno, Vivet Mireia Morera, Cabre Helena Morera, Martinez Raul Moya, Hernandez Ricardo Muliterno, Souza Guillem Mundi, Rico Matilde Muñoz, Quiles Aldara Muñoz, Oliva Eva Muñoz, Herrera M Isabel Muñoz, Álvaro Muriel, Jessica Navarro Rodriguez, Rosa Natalia Navea, Iglesias M Asuncion Neira, Blanco Nerea, Ibañez Rita Maria Nogales, Viera Raquel Novillo, Manrique Maria Pilar Nuñez, Martinez Judith Obiols, Gonzalez Albert Obiols, Fernandez Maria Jose Ocaña, Maisterra Olga, Sanzo Pau Olivares, Cavero Marta Olive, Orgaz Marcos Orejuela, Barrachina Oriol, Aguiló Oriol, Bernal Bàrbara Palau, Reig Roger Pallares, Reyes Juan Manuel Palmero, Lozano Ricardo Pardo, Torrabadella Mari Alba Parella, Torres Xenia Partegas, Berengueras Ivana Pascual, Barrameda Feliciano Penela, Villar Carla Montserrat Pera, Sole Pedro Perez, Restrepo Maria Alejandra Perez, Oset Mireia Perez, Gamez Anna Perez, Suazo Núria Piñana, Yeste Raquel Planas, Mangado Anna Planells, Palome Planels, Pujol Ramon Pons, Minguillon Sergi Pons, Conde Camilo Postius, Arruñada Jose Antonio Prieto, Ajenjo Monica Prieto, Fondevila Noemi Pubill, Carbonell Alba Puertas, M Soledad Querol, Pol Quintana, Joan Quintana, Lourdes Quinteiro, Angels Rabella, Alejandro Ramis, Judith Ramon, Cristina Rebollar, Helena Recasens, Maria del Carmen Reyes, Marc Ribas, Merce Ribera, Javier Rico, Joaquin Rios, Joaquim Roca, Martin Rodrigo, Tello Mar Rodriguez, Pereira Virginia Rodriguez, Pareja Obed Rodriguez, Navarro Yolanda Rodriguez, Muñoz Raquel Rodriguez, Marta Rodriguez, Inma Rodriguez, Fuertes Mariola Rodriguez, Franco Amalia Rodriguez, Piñar Francisco Javier Rodríguez, Gómez José Carlos Rodríguez, Amorodjo Rollmy, Pereda Sandra Romero, Gracia Albert Romero, Molina Jose Ramon Ropero, Mata Jordi Rosell, de Eugenio Ramon Rovira, Brunet Silvia Rovira, Turiel Dominica Ruana, López Verònica Rubio, Guerra Rubio, Baena Antonio Ruiz Llorens Priscila Rubio, Lopez Silvina Rueda, Esteve Ruiz, Castaño Gerard Sabat, Lara Marc Sabata, Fort Jesus Sabate, Bashir Viturro Saima, Saborido Laura Sainz, Llamazares Julia Sala, Ramírez Manel Salmerón, Rudilosso Salvatore, Juan Alaez Carolina San, Valero Pere Sanchez, Segura Daniel Sanchez, Gonzalez Jose Sanchez, Gonzalez Baltasar Sanchez, Bacca Sandra, Soldevilla Jordi Santasusana, Castejón Santiago, Martinez Sheila Santos, Arevalo Maria Jose Santos, Salmeron Marta Sanz, Perez Paola Sastre, Porcel Anna Sedo, Agámez Antonio Carlos Segovia, Perez Enriqueta Segura, Creus Albert Serra, Balcells Maria Serra, Dalmau Noemí Serrano, Villar Mireia Sevil, Lopez Rossana Sierra, Chavez Eduardo Sierra, Encarnación Sorilandy, Borrega Cristina Soro, Garcia Maria Angeles Soto, Gomez Maria Teresa Subirats, Mainero Gonzalo Gabriel Sumasi, Fores Meritxell Tapia, Escribano Francisco Tebar, Montoya Ignacio Teixidor, Bernad Gemma Tellez, Vicente Cristina Tena, Salinas Ester Ines Tierno, Mameghani Toghrol, Testa Soledad Toledo, Masa Miquel Torello, Garcia-Penche Anna Torrano, Romero Judit Torres, Garcia Pedro José Torres, Esparza Nuria Torres, Guixens Marta Trayner, Alvarez Jose Trenado, Calveres Anna Trepat, Longaretti Giovanna Turata, Torres Ricard Turbau, Florenc Uku, Bojaryn Urszula, Lopez Maria Mercedes Val, Primo Ana Maria Valencia, Hernandez Sandra Valle, Gonzalez Ingrit Vazquez, Gil Fernando Vazquez, De la Paz Angel Vazquez, Blanco Garazi Vazquez, Lopez Miguel Ventosa, Arnella Maria Ventura, Carrion M Isabel Verdes, Lopez Juan Jose Verge, Raileau Vergilin, Domenech Narcis Vicente, Meler Natalia Vidal, Cots Eva Vilalta, Jimenez Maria Jose Vilches, Esteo Olga Villena, Muñoz Silvia Viñuales, Fernandez Angela Visser, Gavin Carla Viu, Elisabeth Vives, Pertegaz Nuria Vives, El Abidi Khadija, Josep Abos Navarro, Vanessa Adell, Núria Agramunt, Cristina Aguar Peñalver, Khlifi  Alami Rajaa, Jaume Albà, Montse Alemany Martí, Berta Alemany Perna, Jesus Alexander Gonçalves, Maria-Cruz Almendros, Miriam Almendrote, Marta Álvarez, Sergio Amaro, Miquel Amate, Joan Amaurys Martínez Solano, Genis Amill Vallve, Maria Ángels Casas Capdevila, Alicia Anguita, Jose Antonio Herrera, Jose Antonio Martos Gutierrez, Sonsoles Aranceta, Gastón Araujo, Andrea Arbex, Helena Ariño, Itziar Arrieta, Pablo Arroyo, Victor Augusto Vera Monge, Carles Badenas, Mònica Baldrich Mora, Alferez Baquero Mar, Montse Barcons, Maria Barcons, Patricia Barragan, Josep Bassa Real, Xavier Basurto, Laura Bau Vila, Neker Bejarano, Ana Belén Montero Alvaredo, Ikram Benabdelhak, Anna Berbel, Oscar Bernal, Juan Bernardo Gómez, Leon Berrar Monica, Sarah Besora, Jordi Bigas Farreres, Paula Bisbe, Anunciación Boltes, Sandra Boned, Francesc Boneu, Judit Borras, Sergi Borrego, Irene Bragado Trigo, Joaquin Broto, Anna Bullón, Pablo Burbano, Marco Bustamante, Alejandro Bustamante, Nuria Caballol, Ana Cabanelas Barranco, Eulalia Cabot de Vega, Luis Cajamarca, Jaume Campdelacreu, Miguel Campodarbe Maria, Sergio Campoy, Pol Camps, Tamara Canento, Tamara Canento Sánchez, Luis Cano, David Cànovas, Pere Cardona Portela, José Carlos Molina, Juan Carlos Palacio, Dolors Carrión Duch, Virginia Casado Ruiz, Lozano Casals Jessica, Francesc Casarramona, Nicolas Madrid Castellano, Gislaine Castilho, Esther Catena Ruíz, Nuria Cayuela, Gabriel Celedón, Ángel Chamorro, Jordi Ciurans, Jordi Ciurans Molist, Dolores Cocho Calderón, Cristina Coll, Anna Coll, Laia Collado Borrego, Adrian Colom Orri, Gemma Comellas Vilanova, Laura Comes Romero, Anna Conillera Sole, Gerard Corominas, Xavier Costa Subirós, Anna Cots Foraster, Montserrat Cots Torres, Sorin Cracan, Monica Crosas, Maricelys Cruz, David Cruz, Elisa Cuadrado Godia, Nuria Cuchi Estepa, Lina Cuellar, Marta Cufí Benet, Joaquim Danès Alberto Tavera, Daniella Nunes, Julian David Higuera, Manuel Daza López, Mercedes de Lera, Albert de Luis Sanchez, Marc de Sostoa Graell, Matías Deck, Laura del Rio Lopez, Tania Delgado, Raquel Delgado, Beatriz Delgado Compte Sandra, Glòria Díaz, Manuel Domínguez Lizarbe, Javier Donaire, Laura Dorado, Sorina Dumitras Ruth, Carmen Cobos, Lorena Elias, Merchan Encinas Noelia, Karol Enrique Uscamaita, Sonia Escalante, Jaume Español, Jordi Espinosa, Jordi Espinosa Garcia, Jordi Estela, Patricia Esteve Belloch, Guillermo Eudaldo Albert, Neus Falgàs, Mercedes Falip, Enric Farik, Meritxell Feliu, José Félix Oletta, Víctor Fernández, Nora Fernández, Amelia Fernández Álvarez, Eva Fernandez Climent, Susana Fernández González, Cristina Fernandez Sanchez, Tomàs Figueras Lluis, Marta Fiter Crespo, Alan Flores, Mònica Folqué, Maria Àngels Font, Yolanda Font Casas, Sara Forcén, Eduardo Fraiz, Maria Francia Colina, Elisabet Franquet, Lidia Fuentes, Lourdes Gabarró, Jéssica Garcia, Cristina García, Carmen García, Alicia Garrido, M Angeles Garrido Morales, Roger Gavilán, Mireia Gea, Gemma Gemma Sanchez, Francesc Gibert, Ariadna Gifreu, Francisco Gil, MPilar Gil Villar, Laura Giménez, Georgina Giménez, Gina Gina Santos, Eva Giralt Steinhauer, Roser Gómez, Bárbara Gómez, Lucía Gómez Pía, Manuel Gómez-Choco, Meritxell Gomis, Paula González, Josep González, Cristina González, Belén González, Goran Anastasovski, Montse Gorchs Molist, Sebastia Gornals Meritxell, Aitor Gorriz, Laia Grau, Laura Griu, Albert Gual Falip, Nicolas Guanyabens, Nicolau Guanyabens Buscà, Gemma Guardia Valls, Lucas Guarque Isaac, Mar Guasp, Laura Gubieras, Miguel Guerrero, Núria Guillen, Daniel Guisado, Adnan Hachem, Herctor Cruz Tabuenca, Sara Hernández Luque, Guillermo Hernández Perez, María Hernández-Pérez, Mariona Hervas, Verònica Hidalgo, Iago Iago Payo, Roig Iniesta Alicia, Mar Irida Lloret Villlas, Maria Isabel Gómez Ruiz, Ana Isabel Hernandez, Lourdes Ispierto, Javier Javier Diez de los Ríos, Javier Javier Gimeno, Angel Javier Ois Santiago, Marta Jiménez, Jordi Jimenez Conde, Juan Jiménez Oyonarte, Javier Joaquín Sotova, Juan José Mengual, Joan Josep Baiges, Joan Josep Canet, Miriam Jover, Mireia Judit Garrofé Seira, Edurne Judith Fernandez Toledo, Jesús Juega, Gustavo Jurado, Jerzy Krupinski, Delón la Puma, Cristina Lafuente, Marian Lamolla, Blanca Lara Rodríguez, Nadina Latorre, Laura Laura Robles, Juliench Liesa Sandra Alicia, Mireia Llop Trujillano, Lluis Lluís Gonzalo Oliva, Laura Llull, Cintie López, Mercè López Amorós, Daniel López Domínguezl, Judith Lopez Escuin, Yolexis López Vargas, Elena López-Cancio, María López-Diéguez, Manuel Lozano, Gianni Lucchetti, Giuseppe Lucente, Ludgi Ludgi Vivoda, Juan Luis Becerra, Josep Maria Soler Insa, Josep Maria Alonso Camp, Sonia Maria García Sánchez, Alba Mañé Martínez, Carla Marco Cazcarra, Lorente Marco Tania, Rafael Marés, Liza Margarita Miniello, Josep Maria Aragonés, Rebeca Marín, Fabian Márquez, Elena Martí, Joan Martí Fábregas, Lorena Martin, Julián Martín, Gisela Martín Ozaeta, Felix Martin Purificacion, Lorenzo Martin Ruth, Santacana Martin Yolanda, Yarles Martínez, Alejandro Martínez Domeño, Fructuos Martinez Raquel, Alicia Martínez-Piñeiro, Clara Marzal, Natalia Mas Sala, Elisabeth Matas, Nuria Matos, Gerard Mauri Capdevila, Jorge Medina, Joaquim Mejias Sendra, Mora Mellado Emma, Francesca Mellado Valero, Luis Mena Romo, Jordi Mercadal, Jose Miguel Contador, Mónica Millán, Mireia Mireia Pallisera, Ane Miren Crespo, Julia Miró, Mauricio Molina, Jessica Molina, Carlos Molina, Neus Mongay Ochoa, Carmen Montejo, Angela Monterde Ortega, Shyrlei Morales, Claudia Mormeneo, Nicolás Morón, Marian Muchada, Lucía Muñoz, Albert Muñoz, Gemma Muñoz Gamito, Desiree Muriana Batiste, Eloisa Nieto Clara Gris Ambrós, Antonio Nogueroles, Ana Núñez, Matilde Nuria López Claverol, Cristina Olaizola, Marta Olivé Gadea, María Orriols, Juan Ortiz, Oscar Mascaró, Teresa Osuna, Jorge Pagola, Andrés Paipa, Antonio Palasi Franco, Ernest Palomeras Soler, Oscar Pardina, Laura Pardo Albiñana, Martí Paré, Francesc Paris Pujol, Vanesa Pascual, Paula Paula Rodríguez, Claudia Pedroza, Hector Pelaez Roman, Anna Pellisé Guinjoan, Pilar Pérez, Judit Perez de Celis, Natalia Pérez de la Ossa, Marc Pérez Oliveras, Maria Pilar Fossas Felip, Maria Pilar Sanz Cartagena, Carmen Pirela, Xavier Pla, Jaume Pla Soler, Anna Planas, Pilar Pons Mellado, Eduard Portell, Feliu Pradas Margarita, Luís Prats, Silvia Presas, Montserrat Puig Pastalle, Elsa Puiggrós Rubiol, Carol Pujalte, Lluis Pujol, Francesc Purroy García, Helena Quesada García, Alejandro Quílez, Enric Ramon Albert Segui, Oscar Ramos, Anna Ramos, Alba Ramos, Laura Redondo Parejo, Carles Regordosa, Montserrat Reina Garrido, Arturo Renú, Carmen Repullo Vilchez, Manuel Requena, Silvia Reverté, Anna Reverter, David Reyes, Esteban Reynaga, Victoria Reynoso, Yolanda Riba, Anna Ribera, Elisenda Ribera Tasa, Richard Van der Kleyn, Errando Ricol Javier, Augusto Robles, Mireia Roca, Claudia Roca, Millares Roca M  Jesus, Adriana Rodriguez, Puri Rodríguez, Noelia Rodríguez, Luis Rodríguez, Fernando Rodríguez, Alejandro Rodríguez, Ana Rodríguez Campello, David Rodriguez-Luna, Josep Roig, Elisabet Roldán, Primitivo Romera Cid, Gemma Romeral Ballester, Ruth Romero, Lucía Romero, Marta Ros, Carmen Rosas, Marta Rubiera, Marta Rubio, María Ruiz, Cristhian Ruiz, Tomas Ruperez Marina, Maria Rybyeva, Meritxell Sabartés Guixes, Josep Sabaté Ortega, Victoria Sala, Augusto Salazar Talavera, Fernando Salleres Nuñez, Esther Salvador, Mercè Salvat Plana, Daniela Samaniego, David Sambrano, Jordi Sanahuja Montesinos, Almudena Sanchez, Francisco Sanchez, Elena Sánchez, Pablo Sánchez Cervilla, Raquel Sánchez del Valle, Modesto Sánchez Zambrana, Josep Sanchez-Ojanguren, Estela Sanjuan, Eduardo Sanjurjo Golpe, Gemma Sansa, Estevo Santamarina, Katherine Santana, Júlia Saura Salvado, Joaquín Serena Leal, Laia Seró, Marcos Serrano, Yolanda Silva Blas, Marta Simó, César Socolich, Nuria Solà, Silvia Solà Muñoz, Lucia Sola Soto, Berta Solano Vila, Sonia Sonia Huertas Folch, Agustín Sorrentino, Íñigo Soteras Martínez, Rashida Soultana, Teresa Subirana, Beatriu Suescun Ribas, Silvia Teixidor, Elisabeth Téllez Marín, Mikel Terceño Izarra, Maria Teresa Peris Morales, Antonio Tomás Cano Orgaz, Laia Tomas Chaume, Mónica Torres, Itzaina Torvisco Zulma, Josep Trenado Alvarez, Benito Tudela Teresa, Jaione Urdangarin Etxetxikia, Xabier Urra Nuin, Xavier Ustrell Roig, Juan Valencia Molina, Patricia Valentina Vérez Santamaria, Sebastian Valenzuela, Cecile Van Eendenburg, Alicia Vaqueiro Lorenzo, Martha Vargas, Cristina Vaz Lopes, Daniel Vázquez, Dulce Velásquez, John Velázquez, Paola Vélez, Xavier Verdera García, Margarida Vergés i Sala, José Vicente Hervás, Mikel Vicente Pascual, Nuria Vidal, Montserrate Vidal Silvia, Guillem Vila, Inés Vilà Panés, Montserrat Vila Planavila, MaCristina Villaescusa Urbaneja, Antoni Viñas, Jaume Viñas i Gaya, Lizbeth Yataco, Yosmairy Yoselin Ferrini, Javi Zamarreño, Josep Zaragoza, Nuole Zhu, Muhammad Zidane Bukaei, Irati Zubizarreta
Journal: JAMA (2022)

Importance In nonurban areas with limited access to thrombectomy-capable centers, optimal prehospital transport strategies in patients with suspected large-vessel occlusion stroke are unknown. Objective To determine whether, in nonurban areas, direct transport to a thrombectomy-capable center is beneficial compared with transport to the closest local stroke center. Design, Setting, and Participants Multicenter, population-based, cluster-randomized trial including 1401 patients with suspected acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy in Catalonia, Spain, between March 2017 and June 2020. The date of final follow-up was September 2020. Interventions Transportation to a thrombectomy-capable center (n = 688) or the closest local stroke center (n = 713). Main Outcomes and Measures The primary outcome was disability at 90 days based on the modified Rankin Scale (mRS; scores range from 0 [no symptoms] to 6 [death]) in the target population of patients with ischemic stroke. There were 11 secondary outcomes, including rate of intravenous tissue plasminogen activator administration and thrombectomy in the target population and 90-day mortality in the safety population of all randomized patients. Results Enrollment was halted for futility following a second interim analysis. The 1401 enrolled patients were included in the safety analysis, of whom 1369 (98%) consented to participate and were included in the as-randomized analysis (56% men; median age, 75 [IQR, 65-83] years; median National Institutes of Health Stroke Scale score, 17 [IQR, 11-21]); 949 (69%) comprised the target ischemic stroke population included in the primary analysis. For the primary outcome in the target population, median mRS score was 3 (IQR, 2-5) vs 3 (IQR, 2-5) (adjusted common odds ratio [OR], 1.03; 95% CI, 0.82-1.29). Of 11 reported secondary outcomes, 8 showed no significant difference. Compared with patients first transported to local stroke centers, patients directly transported to thrombectomy-capable centers had significantly lower odds of receiving intravenous tissue plasminogen activator (in the target population, 229/482 [47.5%] vs 282/467 [60.4%]; OR, 0.59; 95% CI, 0.45-0.76) and significantly higher odds of receiving thrombectomy (in the target population, 235/482 [48.8%] vs 184/467 [39.4%]; OR, 1.46; 95% CI, 1.13-1.89). Mortality at 90 days in the safety population was not significantly different between groups (188/688 [27.3%] vs 194/713 [27.2%]; adjusted hazard ratio, 0.97; 95% CI, 0.79-1.18). Conclusions and Relevance In nonurban areas in Catalonia, Spain, there was no significant difference in 90-day neurological outcomes between transportation to a local stroke center vs a thrombectomy-capable referral center in patients with suspected large-vessel occlusion stroke. These findings require replication in other settings. Trial Registration ClinicalTrials.gov Identifier: NCT02795962