LB1 - Evaluation of Direct Transfer to Angiography Suite vs. Computed Tomography Suite in Endovascular Treatment of Stroke: ANGIO-CAT Randomized Clinical Trial
Author Block: Manuel Requena, María Ángeles Muchada, Álvaro García-Tornel, Vall d'Hebron Hosp, Barcelona, Spain; matias deck, barcelona; sandra boned, barcelona, Barcelona; David Hernández, Vall d'Hebron Univ Hosp, Barcelona, Spain; Carlos Piñana, Humberto Díaz-Silva, Vall d'Hebron Hosp, Barcelona, Spain; David Rodriguez-Luna, Neurovascular Unit. H Vall Hebron, Barcelona; Noelia Rodriguez-villatoro, STROKE UNIT VALL DHEBRON UNIVERSI, Barcelona; Jesus MARIA Juega, HOSPITAL VALL HEBRON - UNITAT ICTUS, Barcelona; Jorge Pagola, Fundacio Recerca Vall D Hebron, Barcelona; Marta Olivé-Gadea, Vall d'Hebron Hosp, Barcelona, Spain; Marta Rubiera, HOSPITAL Vall de Hebron, Barcelona; Carlos Molina, HOSPITAL Vall de Hebron, Barcelona, Barcelona; Alejandro tomasello, Vall d Hebron Hosp, Barcelona, Spain; Marc Ribo, HOSPITAL VALL D HEBRON, Barcelona, Spain
Disclosure Block: M. Requena: None. M. deck: None. S. boned: None. D. Rodriguez-Luna: None. N. Rodriguez-villatoro: None. J.M. Juega: None. J. Pagola: None. M. Rubiera: None. C. Molina: Other; Modest; AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb. A. tomasello: None. M. Ribo: Ownership Interest; Significant; Anaconda Biomed. Honoraria; Significant; Medtronic, Stryker. Honoraria; Modest; Cerenovus, Apta Targets, Vesalio.
IntroductionDirect transfer to angio-suite (DTAS) of patients with a suspected large vessel occlusion (LVO) stroke has been described as an effective measure to reduce workflow time in candidate patients for endovascular treatment (EVT). We designed a randomized-controlled trial to study the impact of DTAS on clinical outcome as compared to conventional imaging workflow (NCT04001738).MethodsDuring 20 months we randomly assigned (1:1) patients with suspected LVO stroke (prehospital RACE>4 and NIHSS>10 on arrival, <6 hours from stroke onset) to follow either DTAS (indication based on flat panel NCCT) or direct transfer to CT (conventional CT/CTA +/- CTP) to assess the indication of EVT. Patients were stratified according to transfer from primary center vs. direct admission. Safety outcomes were symptomatic ICH and in-hospital mortality in all patients. Primary efficacy outcome was the shift analysis of the modified Rankin scale (mRS) at 3 months in patients with LVO (ITT population) assessed by blinded external evaluators. Enrollment was stopped after evaluation of pre-planned interim analysis of first 150 patients.ResultsMean age was 73.0 (±13.1) years, onset to door time was 224.9 (±103.4) minutes, median admission NIHSS 18 (14-21) and rate of direct admissions 32.6%; no significant differences in baseline variables were observed between groups. Rates of spontaneous ICH (7.8% vs. 5.5%; p=0.57), LVO strokes (84.4% vs. 86.3%; p=0.81) and iv-tPA treatment (52.3% vs. 50.8%; p=0.57) were balanced between groups. In the ITT (n=128) population EVT was not performed in 9.5% of DTCT patients vs. 0% in the DTAS (p=0.01). DTAS reduced door to groin (19 (IQR 15-24) vs. 43 (37-52) minutes; p<0.01) and onset to reperfusion times (277.2 (±110) vs. 331.0 (±121) minutes; p=0.015). DTAS reduced the severity of disability over the range of the mRS (aOR for improvement of 1 point, 2.14; 95% confidence interval [CI], 1.10 to 4.18; p=0.014). Symptomatic ICH (1.4% in DTAS vs. 7.2% in DTCT; p=0.09) and in hospital mortality rates (6.2% vs. 11.1%; p=0.32) were comparable. ConclusionAmong patients with LVO admitted within 6 hours after symptom onset, direct transfer to angiography suite reduced onset to reperfusion time and improved the post-stroke disability at 90 days.