Abstract / Summary
Abstract Timely interhospital transfer is critical for mechanical thrombectomy (MT) in acute ischemic stroke with large vessel occlusion (LVO). We measured consultation-to-puncture (CTP) time, identified delay segments, and analyzed system factors and clinical outcomes within a 10-hospital metropolitan public referral network served by a single comprehensive stroke center hub. This retrospective cohort study included consecutive LVO patients referred from network hospitals to the hub for MT between October 2021 and September 2024 (fiscal years 2022 to 2024). Timestamps were abstracted from electronic medical records, imaging metadata, stroke-team communication logs, and the neurointerventional procedure registry. The primary outcome was CTP time (first consultation to arterial puncture); the prespecified target was ≤120 minutes. Intervals were summarized as median (interquartile range, IQR). Interval durations were recomputed directly from the recorded timestamps. CTP time was compared across system factors using Mann–Whitney U tests and Kruskal–Wallis tests, with Holm adjustment for multiple comparisons. Multivariable logistic regression modeled CTP time above the cohort median, with Firth penalized regression as a sensitivity analysis; Spearman correlation assessed the relationship between CTP time and the 90-day modified Rankin Scale (mRS). Sixty-six patients were included (median age 66 years; median NIHSS 16). Median CTP time was 194 (IQR 169–219) minutes; one patient (1.5%) met the 120-minute target. Delay was distributed across departure-to-arrival (median 67 minutes), arrival-to-puncture (61 minutes), and acceptance-to-departure (51 minutes); median door-in-door-out time was 186 minutes. CTP time was nominally shorter for consultations outside official hours (191 vs. 210 minutes, unadjusted p = 0.016) but this did not survive adjustment for multiple comparisons (Holm-adjusted p = 0.16) or multivariable adjustment. No system factor independently predicted prolonged CTP time. Successful reperfusion (thrombolysis in cerebral infarction ≥2b) was achieved in 81.5%, a 90-day mRS ≤2 was achieved in 53.0%, and symptomatic intracranial hemorrhage occurred in 1.5%. CTP time did not correlate with 90-day mRS (ρ = 0.089, p = 0.477). In this metropolitan hub-and-spoke network, CTP time substantially exceeded the 120-minute target, with delay distributed across pre-departure, transport, and in-hub phases rather than concentrated in one segment. Reperfusion and functional outcomes were nonetheless within the range reported for transferred patients. System-level interventions – prehospital notification, cloud-based image transfer, and parallel transfer workflows – warrant prospective evaluation.