Comparison of interhospital transfer and direct presentation for mechanical thrombectomy in the treatment of acute ischemic stroke in a major US metropolitan area

Q: What are the key findings of this study?

Interhospital transfer for mechanical thrombectomy in acute ischemic stroke resulted in similar rates of mRS 0-2 compared to direct presentation, despite treatment delays.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke (n=193). Intervention: Interhospital transfer vs. Direct presentation. Primary outcome: mRS 0-2 (p=0.38).

Q: What does this research mean for the field?

Acute ischemic stroke patients transferred to a comprehensive stroke center for mechanical thrombectomy achieve similar clinical and angiographic outcomes to patients presenting directly, despite significantly longer onset-to-treatment times. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Elsa A. Olson; Christina A Rogers; Manhal M. Siddiqi; Jacob S. Riccio; Bichun Ouyang; Sarah Song; R Webster Crowley; Michael Chen; Laurel J. Cherian; Stephan A. Munich

doi:10.1016/j.jstrokecerebrovasdis.2026.108750

September 16, 2026Journal of Stroke and Cerebrovascular DiseasesOpen Access

Comparison of interhospital transfer and direct presentation for mechanical thrombectomy in the treatment of acute ischemic stroke in a major US metropolitan area

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Key result

Interhospital transfer for thrombectomy shows similar functional outcomes compared to direct presentation.

P=0.38
n=193

Why the study?

Timely intervention and treatment at comprehensive high-volume centers improve outcomes in AIS, but the impact of interhospital transfer versus direct presentation on outcomes was unclear.

Does interhospital transfer for mechanical thrombectomy worsen clinical and radiographic outcomes compared to direct presentation in patients with acute ischemic stroke?

Key Points

To compare clinical and radiographic outcomes in acute ischemic stroke patients receiving mechanical thrombectomy between direct presentation and interhospital transfer.
Retrospectively analyzed data from N=193 patients with acute ischemic stroke who underwent mechanical thrombectomy at a single academic comprehensive stroke center.
Compared baseline characteristics, procedural timing, and clinical outcomes between transferred patients (n=157, 81.3%) and direct presentations (n=36, 18.7%).
Direct-presentation patients experienced shorter median last known well-to-arrival (1.83 vs 6.17 hours, p < 0.0001) and last known well-to-puncture times (4.12 vs 6.67 hours, p = 0.001) compared to transferred patients.
Neurological improvement and functional outcomes were comparable between direct presentation and transferred cohorts: median change in NIHSS was -7.5 vs -7 (p = 0.54), median discharge NIHSS was 3.5 vs 5 (p = 0.24), and mRS 0-2 rates were 38.9% vs 31.2% (p = 0.38).
Successful reperfusion rates (TICI 2b-3) did not differ significantly between direct presentation (86.1%) and transferred patients (88.4%, p = 0.78).

Study Design

Type

Cohort (n=193)

Multicenter

No

Structured PICO

Does interhospital transfer for mechanical thrombectomy worsen clinical and radiographic outcomes compared to direct presentation in patients with acute ischemic stroke?

P

Population

193 patients with acute ischemic stroke who underwent mechanical thrombectomy at a single comprehensive stroke center, retrospectively analyzed to compare interhospital transfer versus direct presentation.

E

Exposure

Interhospital transfer to a comprehensive stroke center for mechanical thrombectomy (n=157)

C

Comparator

Direct presentation to the comprehensive stroke center for mechanical thrombectomy (n=36)

O

Outcome

Clinical and radiographic outcomes including change in NIHSS from initial to discharge, discharge NIHSS, rates of modified Rankin Scale (mRS) 0-2, and rates of Thrombolysis in Cerebral Infarction (TICI) 2b-3

Main Result

Absolute Event Rate: 31.2% vs 38.9%

p-value: p=0.38

Interhospital transfer of acute ischemic stroke patients for mechanical thrombectomy does not appear to compromise clinical or radiographic outcomes compared to direct presentation, despite treatment delays.

Limitations

Whether earlier treatment at a lower-volume center would have yielded comparable or superior outcomes cannot be determined from this study.
Retrospective, single-center design
Cannot determine whether earlier treatment at a lower-volume center would have yielded comparable or superior outcomes

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Implication

Transfer for MT yields similar outcomes despite delays; leaves open optimized triage strategies in observational data.

Abstract

BACKGROUND AND OBJECTIVES: Timely medical and procedural intervention has been a tenet of the management of patients with acute ischemic stroke (AIS). Treatment at a comprehensive, high-volume center consistently has been associated with improved clinical outcomes. At times, these principles of management may be in conflict with each other when patients do not present directly to a comprehensive, experienced center. METHODS: We retrospectively analyzed the data from 193 patients with AIS who underwent mechanical thrombectomy (MT) at a single center, academic comprehensive stroke center, comparing clinical and radiographic data for patients who were transferred (157 (81.3%)) to those who presented directly to our center (36 (18.7%)). RESULTS: Patients who presented directly had shorter last known well (LKW)-to-arrival and LKW-to-puncture time compared to those who were transferred (median 1.83 hours vs 6.17 hours (p < 0.0001) and median 4.12 hours vs 6.67 hours (p = 0.001), respectively). Patients presenting directly and those who were transferred had similar change in NIHSS from initial NIHSS to discharge NIHSS (median -7.5 vs -7 (p = 54), respectively), similar discharge NIHSS (median 3.5 vs 5 (p = 0.24), respectively), similar rates of mRS 0-2 (38.9% vs 31.2% (p = 0.38), respectively) and similar rates of TICI 2b-3 (86.1% vs 88.4% (p = 0.78), respectively). CONCLUSIONS: Despite longer LKW-to-arrival and LKW-to-puncture times, transferred AIS patients had similar clinical and radiographic outcomes following MT compared to those presenting directly to our center. These findings suggest that, within this cohort, the time needed for transfer to an experienced center was not associated with worse outcomes compared to direct presentation. Whether earlier treatment at a lower-volume center would have yielded comparable or superior outcomes cannot be determined from this study.

Discussion

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Cite This Study

Olson et al. (2026) conducted a cohort in Acute ischemic stroke (n=193). Interhospital transfer vs. Direct presentation was evaluated on mRS 0-2 (p=0.38). Interhospital transfer for mechanical thrombectomy in acute ischemic stroke resulted in similar rates of mRS 0-2 compared to direct presentation, despite treatment delays.

synapsesocial.com/papers/6ad0fd1915427f6a84040519 https://doi.org/10.1016/j.jstrokecerebrovasdis.2026.108750

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Comparison of interhospital transfer and direct presentation for mechanical thrombectomy in the treatment of acute ischemic stroke in a major US metropolitan area

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Comparison of interhospital transfer and direct presentation for mechanical thrombectomy in the treatment of acute ischemic stroke in a major US metropolitan area

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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