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Transport Strategy in Patients With Suspected Acute Large Vessel Occlusion Stroke: TRIAGE-STROKE, a Randomized Clinical Trial

医学 改良兰金量表 溶栓 冲程(发动机) 随机对照试验 优势比 急诊分诊台 闭塞 内科学 腹股沟 外科 急诊医学 缺血性中风 缺血 心肌梗塞 工程类 机械工程
作者
Anne Behrndtz,Rolf Ankerlund Blauenfeldt,Søren Paaske Johnsen,Jan Brink Valentin,Martin Faurholdt Gude,Mohammad Ahmad Al-Jazi,Paul von Weitzel-Mudersbach,Boris Modrau,Dorte Damgaard,Kristina Dupont Hougaard,Niels Hjort,Tove Diedrichsen,Marika Poulsen,Marie Louise Schmitz,Marc Fisher,Grethe Andersen,Claus Z. Simonsen,B. Sandahl,Lise Leth Jeppesen,Rikke Bay,Kristina Eiskær,Malene Højgaard Andersen,Janni Lauridsen,Anne Mette,Anne-Mette Sottrup-Jensen,Nina Boje Kibsgaard Jensen,Maiken Hansen,Jesper Tørring Margret,Anna Ochonske,Morten Stilund,Georgi Sirakov,Goran Bekan,Mayoran Perampalam,Zeinaab Maanaki,Masoud Falah,Janne Kaergaard Mortensen,Søren Due,Niels Sanderhoff Degn
出处
期刊:Stroke [Lippincott Williams & Wilkins]
卷期号:54 (11): 2714-2723 被引量:7
标识
DOI:10.1161/strokeaha.123.043875
摘要

BACKGROUND: When patients with acute ischemic stroke present with suspected large vessel occlusion in the catchment area of a primary stroke center (PSC), the benefit of direct transport to a comprehensive stroke center (CSC) has been suggested. Equipoise remains between transport strategies and the best transport strategy is not well established. METHODS: We conducted a national investigator-driven, multicenter, randomized, assessor-blinded clinical trial. Patients eligible for intravenous thrombolysis (IVT) who were suspected for large vessel occlusion were randomized 1:1 to admission to the nearest PSC (prioritizing IVT) or direct CSC admission (prioritizing endovascular therapy). The primary outcome was functional improvement at day 90 for all patients with acute ischemic stroke, measured as shift towards a lower score on the modified Rankin Scale score. RESULTS: From September 2018 to May 2022, we enrolled 171 patients of whom 104 had acute ischemic stroke. The trial was halted before full recruitment. Baseline characteristics were well balanced. Primary analysis of shift in modified Rankin Scale (ordinal logistic regression) revealed an odds ratio for functional improvement at day 90 of 1.42 (95% CI, 0.72–2.82, P =0.31). Onset to groin time for patients with large vessel occlusion was 35 minutes ( P =0.007) shorter when patients were transported to a CSC first, whereas onset to needle (IVT) was 30 minutes ( P =0.012) shorter when patients were transported to PSC first. IVT was administered in 67% of patients in the PSC group versus 78% in the CSC group and EVT was performed in 53% versus 63% of the patients, respectively. CONCLUSIONS: This trial investigated the benefit of bypassing PSC. We included only IVT-eligible patients presenting <4 hours from onset and with suspected large vessel occlusion. Lack of power prevented the results from showing effect on functional outcome for patients going directly to CSC. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03542188.
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