We compared clinical outcomes for those patients with in-house stroke (IHS) who were transferred for mechanical thrombectomy [Spoke-IHS] versus those who were already at a comprehensive stroke center (CSC) [Hub-IHS].

After IRB approval, a retrospective analysis of patients who suffered IHS either at a CSC or transferred from a Spoke for acute intervention from the period of 2014-2018.

A total of 108 patients were included: 84% Spoke-IHS and 16% Hub-HIS. Baseline characteristics were comparable between the two groups. Mean time to last seen well (TLSW) to recognition (TR) was lower in the Hub population (61 vs.72 min, p=.73). TLSW to imaging was lower (83 vs. 99 min, p=.55). Imaging to tPA was lower (17 vs. 70.4 min, p<.05). Average TLSW to groin puncture was lower (120 vs. 213 min, p<.05).  There was increased early improvement in NIHSS (41% vs 31%, p=.4) and decreased early deterioration (11% vs. 15%, p=.7). Rates of symptomatic hemorrhage or parenchymatous hematoma-2 were lower (0 vs.11%). TPA rates were higher (29.4% vs. 16.5%, p=.21). Mortality at discharge was lower in the Hub population (23.5% vs. 32%, p=.49). At 90 days, this was 41.2% vs. 46.5%, respectively (p=.69). Of those with a baseline mRS of 0-2, 28.6% of Hub-HIS had mRS of 0-2 at 90 days vs. 11.7% (p=.1) at Spoke and these were increased to 57.1% and 22.1%, respectively when including mRS of 3 at 90 days (p<0.05).

Those suffering IHS at a CSC had higher rates of tPA, lower rates of significant hemorrhage, increased early improvement, and decreased early deterioration. Functional status at 90 days was increased and mortality was decreased. Those at Hub had decreased time metrics across the board, indicating these are potential areas of improvement.