Impact of Risk Factors and a New Transfer Pathway on Endovascular Thrombectomy Outcomes in Acute Ischemic Stroke.

Abstract

Endovascular thrombectomy (EVT) is a time-critical therapy for acute ischemic stroke caused by large-vessel occlusion. To improve transfer efficiency, a web-based EVT transfer system was implemented in the Taiwan Stroke Network. This study evaluated its impact on workflow metrics and patient outcomes. This retrospective cohort study included AIS patients transferred for EVT between January 2021 and May 2024. Patients were categorized into traditional transfer pathway (TTP) or new transfer pathway (NTP) groups. Given the older age, longer onset-to-door time (ODT), and smaller sample size in the NTP group, propensity score matching (1:1, caliper = 0.1) was conducted using age and ODT. Among 356 patients (TTP: n = 293; NTP: n = 63), 63 matched pairs were analyzed. The NTP group had significantly shorter door-to-computed tomography angiography (12.2 ± 10.7 vs. 39.8 ± 33.8 minutes; P < 0.0001) and door-to-groin puncture times (83.0 ± 24.4 vs. 109.2 ± 44.6 minutes; P < 0.0001). These improvements were associated with better outcomes, including higher 1-month EQ-5D-5L visual analogue scale scores (61.6 ± 31.9 vs. 32.0 ± 30.9; P = 0.004), lower in-hospital mortality (11.1% vs. 31.7%; P = 0.009), and lower 3-month modified Rankin Scale scores (3.8 ± 1.7 vs. 4.6 ± 1.4; P = 0.004). Hypertension and National Institutes of Health Stroke Scale scores at 24-36 hours independently predicted poor functional outcomes. The web-based EVT transfer system improved workflow and functional outcomes, highlighting its value even in a small referral cohort.