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June 14, 2021

Streamlining the Path to Endovascular Reperfusion in Stroke

Author Affiliations
  • 1Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, Parkville, Australia
  • 2Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
JAMA Neurol. 2021;78(8):909-911. doi:10.1001/jamaneurol.2021.1369

In this issue of JAMA Neurology, Sarraj et al1 report on the associations of repeated imaging on arrival at an endovascular thrombectomy (EVT)–capable hospital with clinical outcomes after EVT. They studied an observational cohort of 2533 patients who had ischemic stroke with large vessel occlusion within 24 hours of stroke onset. It is well understood that a favorable outcome depends on the time from stroke onset to reperfusion,2 and there is no doubt that proceeding directly to the angiography suite (DTA) saves time compared with repeating imaging (median time, 26 minutes shorter in Sarraj et al1). Direct transfer to the angiography suite probably also increases the proportion of patients who receive EVT, based on the ANGIOCAT (Evaluation of Direct Transfer to Angiography Suite vs Computed Tomography Suite in Endovascular Treatment) study that was recently reported in abstract form.3 Although results of dedicated randomized trials of EVT for patients with a large irreversibly injured ischemic core are pending, several studies4-6 have suggested that a clinically relevant benefit of reperfusion is preserved in this group, and so increasing the proportion of patients treated may translate to an overall population benefit. Given these factors, it is perhaps not surprising that Sarraj et al1 found an association between a DTA approach and improved rates of functional independence (164 of 312 [52.6%] vs 282 of 563 [37.0%]; adjusted odds ratio, 1.85 [95% CI, 1.33-2.57]; P < .001) and reduced mortality (53 of 312 [17.0]% vs 186 of 763 [24.4%]; P = .008).

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