The Impact of the Bypass Transport Method on Clinical Outcomes After Large Vessel Occlusion: A Pooled-Proportion Meta-Analysis.

Abstract

Strokes are a leading cause of death worldwide, with a majority being ischemic. Treatments include intravenous thrombolytics and mechanical thrombectomy (MT) for large vessel occlusions. With both being time-sensitive, there has been a focus on emergency transport decisions; however, there is a deficit of large, multi-institutional studies to support the use of a bypass transport system where patients suspected of large vessel occlusion are transported directly to a comprehensive stroke center (CSC) even if they bypass other centers. A query was completed of PubMed, Scopus, and Web of Science for articles related to clinical outcomes with the bypass transport method. Patients directly transported to a CSC were compared to patients transferred from a peripheral stroke center. A mixed-effect meta-regression model was used to investigate the effect of patient and treatment variables on 90-day mortality and functional outcome rates. Two hundred sixty articles were included in the final analysis. The time to tissue plasminogen activator treatment was insignificantly but slightly delayed in the direct group (132.1 vs. 130.6 minutes; P value: 0.8823), while the time to MT was significantly faster in the direct group (225.6 vs. 275.4 minutes; P value: 0.0114). Mortality and good neurological outcome rates were not significantly different in these groups (odds ratio=0.7060; 95% confidence interval 0.4802-1.0379 and odds ratio=1.1305; 95% confidence interval 0.8830-1.4473). This meta-analysis compares the 90-day mortality and functional outcomes between patients, and we found a statistically significant improvement in time to MT for those directly transported to a CSC; however, there was not a significant difference in clinical outcomes.