Direct Transfer to Angio Suite Reduces Likelihood of Severe Disability Post Stroke

March 19, 2021
Victoria Johnson
Victoria Johnson

Victoria Johnson, Assistant Editor for NeurologyLive, joined the MJH Life Sciences team in October 2020. Follow her on Twitter @VictoriaJNeuro or email her at vjohnson@neurologylive.com

Researchers also found that compared to direct to CT patients, DTAS patients has lower onset-to-reperfusion and door-to-groin times.

Data from a recent study suggest that the direct transfer to angio-suite (DTAS) of patients with a suspected large vessel occlusion (LVO) stroke improves poststroke disability at 90 days.1

These findings were presented at the American Stroke Association’s (AHA) International Stroke Conference (ISC) 2021, March 17-19, by Manuel Requena, MD, PhD, fellow, neurointerventional radiology, Vall d'Hebron Hospital, Barcelona, Spain. Requena et al noted that DTAS of patients with a suspected LVO stroke has previously been called effective measure in workflow time reduction for those who are candidates for endovascular treatment (EVT).

“Our study is the first clinical trial that shows the superiority of direct transfer to an angiography suite,” Requena said in a statement.2 “Our findings were close to what we expected, and we were surprised that they occurred so early in the study. We trust that they will be confirmed in ongoing, multicenter, international trials.”

Requena and colleagues designed a randomized, controlled clinical trial (ANGIO-CAT; NCT04001738) in order to study the impact of DTAS on clinical outcome as compared to conventional imaging workflow. Over a period of 20 months, patients with suspected LVO stroke were randomly assigned (1:1) to follow either DTAS (indication based on flat panel non-contrast computed tomography) or direct transfer to computed tomography (CT; DTCT: CT angiography and/or CT perfusion) to assess the indication of EVT. 

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Patients were categorized as having suspected LVO stroke if their Rapid Arterial oCclusion Evaluation (RACE) score was over 4 prehospital and their National Institutes of Health Stroke Scale (NIHSS) score was over 10 at arrival. 

Patients were stratified according to transfer from primary center versus direct admission and safety outcomes assessed were symptomatic intracerebral brain hemorrhage (ICH) and in-hospital mortality. The primary efficacy outcome assessed was shift on modified Rankin scale (mRS) at 3 months in patients with LVO.

Requena and colleagues evaluated 150 patients with a mean age of 73.0 years (standard deviation [SD], 13.1). Patients had a mean onset to door time of 224.9 minutes (SD, 103.4), a median admission NIHSS score of 18 (range, 14-21) and a 32.6% rate of direct admissions. 

There were no significant differences observed in baseline characteristics between groups. Rates of spontaneous ICH were similar between groups (7.8% vs 5.5%; P = .57), as were the rates of LVO strokes (84.4% vs 86.3%; P = .81), and intravenous tissue plasminogen activator (iv-tPA) treatment (52.3% vs 50.8%; P = .57).

In the intent to treat population (ITT) of 128 patients, EVT was performed in all DTAS patients and 90.5% of DTCT patients (P = .01). The researchers found that DTAS reduced door to groin time with a mean time of 19 minutes (interquartile range [IQR], 15-24) compared to 43 minutes (IQR, 37-52) in the DTCT group. It also reduced onset to reperfusion times, with a mean time of 277.2 minutes (SD, 110) in the DTAS group compared to 331.0 minutes (SD, 121) in the DTCT group (P = .015).

“Stroke patients transferred directly to an angiography suite were less likely to be dependent for assistance with daily activities compared to the stroke patients who received the current standard of care - CT scan,” Requena said.2 “More frequent and more rapid treatment can help improve outcomes for our stroke patients.”

DTAS reduced the likelihood of severe disability as assessed on the mRS (adjusted odds ratio [aOR] of 1-point improvement, 2.14 [95% CI, 1.10-4.18]; P = .014). Between the 2 groups, symptomatic ICH rates were statistically significant, with 1.4% in the DTAS group and 7.2% in in the DTCT group (P = .09), as were in-hospital mortality rates, with 6.2% in the DTAS group and 11.1% in the DTCT group (P = .32).

“Among patients with LVO admitted within 6 hours after symptom onset, direct transfer to angiography suite reduced onset to reperfusion time and improved the post-stroke disability at 90 days,” Requena and colleagues concluded.

For more coverage of ISC 2021, click here.

REFERENCES
1. Requena M, Muchada MA, Garcia-Tornel A, et al. Evaluation of direct transfer to angiography suite vs. computed tomography suite in endovascular treatment of stroke: ANGIO-CAT randomized clinical trial. Presented at International Stroke Conference 2021; March 17–19. Abstract LB 1
2. Immediate angiography may reduce stroke treatment time, improve recovery, lower disability. News release. March 17, 2021. Accesssed March 18, 2021, https://newsroom.heart.org/news/immediate-angiography-may-reduce-stroke-treatment-time-improve-recovery-lower-disability