PMID- 34794029
OWN - NLM
STAT- MEDLINE
DCOM- 20220204
LR  - 20220204
IS  - 1532-8511 (Electronic)
IS  - 1052-3057 (Linking)
VI  - 31
IP  - 1
DP  - 2022 Jan
TI  - The Role of Vascular Imaging atReferral Centers in the Drip and Ship Paradigm.
PG  - 106209
LID - S1052-3057(21)00614-5 [pii]
LID - 10.1016/j.jstrokecerebrovasdis.2021.106209 [doi]
AB  - BACKGROUND: In drip-and-ship protocols, non-invasive vascular imaging (NIVI) at 
      Referral Centers (RC), although recommended, is not consistently performed and 
      its value is uncertain. We evaluated the role of NIVI at RC, comparing patients 
      with (VI+) and without (VI-) vascular imaging in several outcomes. METHODS: 
      Observational, multicenter study from a prospective government-mandated 
      population-based registry of code stroke patients. We selected acute ischemic 
      stroke patients, initially assessed at RC from January-2016 to June-2020. We 
      compared and analyzed the rates of patients transferred to a Comprehensive Stroke 
      Center (CSC) for Endovascular Treatment (EVT), rates of EVT and workflow times 
      between VI+ and VI- patients. RESULTS: From 5128 ischemic code stroke patients 
      admitted at RC; 3067 (59.8%) were VI+, 1822 (35.5%) were secondarily transferred 
      to a CSC and 600 (11.7%) received EVT. Among all patients with severe stroke 
      (NIHSS >/=16) at RC, a multivariate analysis showed that lower age, thrombolytic 
      treatment, and VI+ (OR:1.479, CI95%: 1.117-1.960, p=0.006) were independent 
      factors associated to EVT. The rate of secondary transfer to a CSC was lower in 
      VI+ group (24.6% vs. 51.6%, p<0.001). Among transferred patients, EVT was more 
      frequent in VI+ than VI- (48.6% vs. 21.7%, p<0.001). Interval times as door-in 
      door-out (median-minutes 83.5 vs. 82, p= 0.13) and RC-Door to puncture 
      (median-minutes 189 vs. 178, p= 0.47) did not show differences between both 
      groups. CONCLUSION: In the present study, NIVI at RC improves selection for EVT, 
      and is associated with receiving EVT in severe stroke patients. Time-metrics 
      related to drip-and-ship model were not affected by NIVI.
CI  - Copyright (c) 2021 Elsevier Inc. All rights reserved.
FAU - Flores, Alan
AU  - Flores A
AD  - Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, 
      Spain. Electronic address: afloresf.hj23.ics@gencat.cat.
FAU - Sero, Laia
AU  - Sero L
AD  - Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, 
      Spain.
FAU - Gomez-Choco, Manuel
AU  - Gomez-Choco M
AD  - Neurology Department, Hospital Moises Broggi, Barcelona, Spain.
FAU - Ustrell, Xavier
AU  - Ustrell X
AD  - Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, 
      Spain.
FAU - Pellise, Anna
AU  - Pellise A
AD  - Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, 
      Spain.
FAU - Vinas, Jaume
AU  - Vinas J
AD  - Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, 
      Spain.
FAU - Rodriguez, Paula
AU  - Rodriguez P
AD  - Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, 
      Spain.
FAU - Monterde, Angela
AU  - Monterde A
AD  - Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, 
      Spain.
FAU - Castilho, Gislaine
AU  - Castilho G
AD  - Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, 
      Spain.
FAU - Rubiera, Marta
AU  - Rubiera M
AD  - Stroke Unit, Neurology Department, Hospital Universitari Vall D' Hebron, 
      Barcelona, Spain.
FAU - Amaro, Sergi
AU  - Amaro S
AD  - Stroke Unit, Neurology Department, Hospital Clinic, Barcelona, Spain.
FAU - Padros, Maria Angels Font
AU  - Padros MAF
AD  - Neurology Department, Hospital Moises Broggi, Barcelona, Spain.
FAU - Cardona, Pedro
AU  - Cardona P
AD  - Stroke Unit, Neurology Department, Hospital Universitari Bellvitge, Barcelona, 
      Spain.
FAU - Marti-Fabregas, Joan
AU  - Marti-Fabregas J
AD  - Stroke Unit, Hospital de Sant Pau, Barcelona, Spain.
FAU - Molina, Carlos A
AU  - Molina CA
AD  - Stroke Unit, Neurology Department, Hospital Universitari Vall D' Hebron, 
      Barcelona, Spain.
FAU - Serena, Joaquin
AU  - Serena J
AD  - Stroke Unit, Neurology Department, Hospital Universitari Josep Trueta, Girona, 
      Spain.
FAU - Jimenez-Fabrega, Francesc Xavier
AU  - Jimenez-Fabrega FX
AD  - Servei d'Emergencies Mediques, Hospitalet de Llobregat, Spain.
FAU - Purroy, Francisco
AU  - Purroy F
AD  - Stroke Unit, Neurology Department, Hospital Arnau de Vilanova, Lleida, Spain.
FAU - Zaragoza-Brunet, Jose
AU  - Zaragoza-Brunet J
AD  - Stroke Unit, Neurology Department, Hospital Verge de la Cinta, Tortosa, Spain.
FAU - Cocho, Dolores
AU  - Cocho D
AD  - Neurology Department, Hospital de Granollers, Granollers, Spain.
FAU - Palomeras, Ernest
AU  - Palomeras E
AD  - Neurology Department, Hospital de Mataro, Mataro, Spain.
FAU - Kuprinski, Jurek
AU  - Kuprinski J
AD  - Neurology Department, Hospital Mutua Terrasa, Barcelona, Spain.
FAU - Mas, Natalia
AU  - Mas N
AD  - Neurology Department, Hospital Althaia, Manresa, Spain.
FAU - Hernandez-Perez, Maria
AU  - Hernandez-Perez M
AD  - Stroke Unit, Neurology Department, Hospital Universitari Germans Trias i Pujol, 
      Badalona, Spain.
FAU - Sanjurjo, Eduard
AU  - Sanjurjo E
AD  - Hospital Comarcal del Pallars, Tremp, Spain.
FAU - Carrion, Dolors
AU  - Carrion D
AD  - Hospital de Mora d'Ebre, Spain.
FAU - Costa, Xavier
AU  - Costa X
AD  - Hospital de Figueres, Spain.
FAU - Barcelo, Miquel
AU  - Barcelo M
AD  - Hospital de Cerdanya, Spain.
FAU - Monedero, Jordi
AU  - Monedero J
AD  - Hospital d'Igualada, Spain.
FAU - Catena, Esther
AU  - Catena E
AD  - Consorci Sanitari Alt Penedes-Garraf. Spain.
FAU - Rybyeba, Maria
AU  - Rybyeba M
AD  - Hospital de Olot, Spain.
FAU - Diaz, Gloria
AU  - Diaz G
AD  - Hospital Campdevanol, Spain.
FAU - de la Ossa, Natalia Perez
AU  - de la Ossa NP
AD  - Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER 
      Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain.
FAU - Ribo, Marc
AU  - Ribo M
AD  - Stroke Unit, Neurology Department, Hospital Universitari Vall D' Hebron, 
      Barcelona, Spain.
CN  - Catalan Stroke Code and Reperfusion Consortium
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
DEP - 20211115
PL  - United States
TA  - J Stroke Cerebrovasc Dis
JT  - Journal of stroke and cerebrovascular diseases : the official journal of National 
      Stroke Association
JID - 9111633
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Brain Ischemia/*diagnostic imaging/therapy
MH  - Endovascular Procedures
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Outcome and Process Assessment, Health Care
MH  - *Patient Transfer
MH  - Prospective Studies
MH  - Stroke/*diagnostic imaging/therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Drip and ship paradigm
OT  - Endovascular treatment
OT  - Organized stroke care
OT  - Referral centers
OT  - Vascular imaging
COIS- Declaration of Competing Interest The author(s) declared the following potential 
      conflicts of interest with respect to the research, authorship, and/or 
      publication of this article: Marc Ribo  has a consulting agreement with: 
      Medtronic, Stryker, Johnson and Johnson, Perflow Medical, Anaconda Biomed and 
      Apta Targets.
EDAT- 2021/11/19 06:00
MHDA- 2022/02/05 06:00
CRDT- 2021/11/18 20:17
PHST- 2021/09/08 00:00 [received]
PHST- 2021/10/21 00:00 [revised]
PHST- 2021/10/26 00:00 [accepted]
PHST- 2021/11/19 06:00 [pubmed]
PHST- 2022/02/05 06:00 [medline]
PHST- 2021/11/18 20:17 [entrez]
AID - S1052-3057(21)00614-5 [pii]
AID - 10.1016/j.jstrokecerebrovasdis.2021.106209 [doi]
PST - ppublish
SO  - J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106209. doi: 
      10.1016/j.jstrokecerebrovasdis.2021.106209. Epub 2021 Nov 15.