Imaging Strategies and Futile Transfers in the Drip-and-Ship Model Within a Densely Connected Stroke Network
Tsai, P.-Y.; Lin, C.-W.; Chang, Y.-M.; Tzeng, R.-C.; Wu, M.-H.; Vong, S.-C.; Chen, T.-S.; Wu, S.-T.; Tsai, Y.-T.; Fang, Y.-T.; Yang, C.-C.; Su, Y.-H.; Huang, M.-H.; Wu, M.-H.; Chu, F.-Y.; Huang, Y.; Lin, K.-H.; Chang, C.-C.; Wu, C.-H.; Wang, C.-M.; Sung, P.-S.
Show abstract
Background and Purpose: Futile interhospital transfers, where patients transferred for endovascular thrombectomy (EVT) do not ultimately receive the procedure, represent a critical systemic burden on stroke transfer network. Whether pre-transfer computed tomography angiography (CTA) at the primary stroke center (PSC) reduces futile transfers, and at what workflow cost, remains incompletely characterized. Methods: This retrospective study enrolled 314 acute ischemic stroke patients transferred for potential EVT within the Tainan-Chiayi Stroke Network (October 2021-September 2025). Patients were stratified by CTA timing: pre-transfer (n=66) versus post-transfer (n=248). Workflow time metrics and 90-day functional outcomes were compared. Futile transfers were classified into three categories: preventable over-triage, physiological futility, and gray zone cases. Results: The futile transfer rate was substantially lower in the pre-transfer CTA group (27.3% vs. 66.1%; P<0.001), with post-transfer CTA as the strongest independent predictor of futility (aOR 5.21; 95% CI 2.83-9.60). In the post-transfer CTA group, 40.2% of futile transfers involved conditions identifiable by pre-transfer CTA. Regardless of CTA timing, gray zone cases predominated in both groups (83.3% vs. 47.6%), driven by intracranial atherosclerotic stenosis/ chronic total occlusion, large infarct cores, and medium vessel occlusions. Pre-transfer CTA significantly prolonged PSC door-in-door-out time (140 vs. 88 min; P<0.001) and showed numerical trends toward longer onset-to-EVT time and lower rates of favorable functional outcome. Conclusions: Adopting CTA during the pre-transfer period reduces preventable futile transfers but prolongs PSC processing time. Nevertheless, the persistent gray zone requires strategies beyond imaging alone, and the trade-off between triage precision and transfer efficiency warrants ongoing evaluation across different stroke networks settings.-
Matching journals
The top 2 journals account for 50% of the predicted probability mass.
Similar papers in this journal
- Prospective Observational Cohort Study Of Tenecteplase Versus Alteplase In Routine Clinical Practice 97%
- Early recanalization among patients undergoing bridging therapy with tenecteplase or alteplase 97%
- Safety Outcomes of Mechanical Thrombectomy Versus Combined Thrombectomy and Intravenous Thrombolysis in Tandem Lesions 96%
Similar papers in this journal
- Prehospital triage of intracranial hemorrhage and anterior large vessel occlusion ischemic stroke: the value of the rapid arterial occlusion evalution 97%
- Large Core Thrombectomy: Feasibility Of Simplified Protocol In Resource-Limited Settings 96%
- Adjunctive Intra-arterial Urokinase after Successful Endovascular Thrombectomy in Patients with Large Vessel Occlusion Stroke (POST-UK): Study protocol of a multicenter, prospective, randomized, open-label, blinded-endpoint trial 96%
Similar papers in this journal
- Intravenous Thrombolysis before Thrombectomy Improves Functional Outcome after Stroke Independent of Reperfusion Grade 96%
- COVID-19 Infection Is Associated with Poor Outcomes in Patients with Intracerebral Hemorrhage 95%
- Disparities in Access to Vascular Stroke Imaging and Carotid Revascularization: A Population Study 95%
Similar papers in this journal
- Quantification of Patent Foramen Ovale Shunt Severity by Transesophageal Echocardiogram and Transcranial Doppler in Routine Clinical Practice 95%
- Modified Rankin Scale Disability Status at Day 4 Poststroke is an Informative Predictor of Long-Term Day 90 Outcome 95%
- White matter lesions as a prognostic marker of recurrence in cryptogenic stroke with high-risk patent foramen ovale 94%
Similar papers in this journal
- Safety and efficacy of management for intraprocedural rupture during endovascular treatment for intracranial aneurysms 94%
- Endovascular thrombectomy for the treatment of large ischemic stroke: a systematic review and meta-analysis of randomized control trials 94%
- Low and Borderline Ankle Brachial Index is Associated with Intracranial Aneurysms – a Retrospective Cohort Study 91%
"Similar papers" are the closest papers from that journal in the model's embedding space. They show what the match is built on, but the ranking comes mostly from a classifier over the whole training set, not from these examples alone.