ArticleJournal of neurointerventional surgery2020
Impact of EMS bypass to endovascular capable hospitals: geospatial modeling analysis of the US STRATIS registry.
Article in Journal of neurointerventional surgery, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02239640 (Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke), which is not on this map. Cited by 13 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Systematic Evaluation of Patients Treated With Stroke Devices for Acute Ischemic Stroke (STRATIS) Registry
Who cites it
13 citing papers in PubMed.
- Trial
- Incidence of mechanical thrombectomy among stroke patients brought directly to a comprehensive stroke center versus transfer from a primary stroke center in upstate New York.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Rural-urban differences in emergency medical services bypass routing of stroke in North Carolina.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2025Article
- Geographic Access to High-Volume Mechanical Thrombectomy Centers in Florida, 2019.Neurology. Clinical practice · 2024Article
- Women With Large Vessel Occlusion Acute Ischemic Stroke Are Less Likely to Be Routed to Comprehensive Stroke Centers.Journal of the American Heart Association · 2023Article
- Intravenous Thrombolysis Is Associated With Better Outcomes in Large-Vessel Occlusion Requiring Endovascular Therapy.Stroke (Hoboken, N.J.) · 2023Article
- Evolving Stroke Systems of Care: Stroke Diagnosis and Treatment in the Post-Thrombectomy Era.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2023Review
- Bypass of Primary Stroke Centers Compared With Secondary Transfer for Endovascular Thrombectomy.Stroke (Hoboken, N.J.) · 2022Article
- Prehospital Stroke Care, Paramedic Training Needs, and Hospital-Directed Feedback in Lithuania.Healthcare (Basel, Switzerland) · 2022Article
- National implementation of reperfusion for acute ischaemic stroke in England: How should services be configured? A modelling study.European stroke journal · 2022Article
- mG-FAST, a single pre-hospital stroke screen for evaluating large vessel and non-large vessel strokes.Frontiers in neurology · 2022Article
- Modeling the Impact of Prehospital Triage on a True-Life Drip and Ship Mechanical Thrombectomy Urban Patient Cohort.Cerebrovascular diseases extra · 2021Article
- Prehospital Triage Strategies for the Transportation of Suspected Stroke Patients in the United States.Stroke · 2020Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRouting patients directly to endovascular capable centers (ECCs) would decrease time to mechanical thrombectomy (MT), but may delay intravenous thrombolysis (IVT).
objectiveTo study the clinical outcomes of patients with a stroke transferred directly to ECCs compared with those transferred to ECCs from non-endovascular capable centers (nECCs).
methodsData from the STRATIS registry were analyzed to evaluate process and clinical outcomes under five routing policies: (1) transport to nearest nECC; (2) transport to STRATIS ECC over any distance or (3) within 20 miles; (4) transport to ideal ECC (iECC), over any distance or (5) within 20 miles.
resultsAmong 236 patients, 117 (49.6%) were transferred by ground, of whom 62 (53%) were transferred within 20 miles. Median MT start time was accelerated in all direct transport models. IVT start was prolonged with direct transport across all distances, but accelerated with direct transport to iECC ≤20 miles. With bypass limited to ≤20 miles, the median modeled EMS arrival to IVT interval decreased for both iECCs and ECCs (by 12 min and 6 min, respectively), and median EMS arrival to puncture time decreased by up to 94 min. In this cohort, no patient would have become ineligible for IVT. Bypass to iECC modeling under 20 miles showed a significant reduction in the level of disability at 3 months, with freedom from disability (modified Rankin Scale score 0-1) at 3 months increased by 12%.
conclusionsDirect routing of patients with a large vessel occlusion to ECCs, especially when within 20 miles, may lead to better clinical outcomes by accelerating the start of MT without any delay of IVT. CLINICAL TRIAL REGISTRATION NUMBER: http://www.clinicaltrials.gov. Unique identifier: NCT02239640.
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