Use, Temporal Trends, and Outcomes of Endovascular Therapy after Interhospital Transfer in the United States

Background: The use of endovascular therapy (EVT) in acute ischemic stroke patients with large vessel occlusion (LVO) has rapidly increased in the US following pivotal trials demonstrating its benefit. Information about the contribution of interhospital transfer in improving access to EVT will help organize regional systems of stroke care. Methods:We analyzed trends of transfer-in EVT from a cohort of 1,863,693 ischemic stroke patients admitted to 2,143 Get With The Guidelines-Stroke participating hospitals between January 2012 and December 2017. We further examined the association between arrival mode and in-hospital outcomes using multivariable logistic regression models. Results:: Of the 37,260 patients who received EVT at 639 hospitals during the study period, 42.9% (15,975) arrived to the EVT providing hospital after interhospital transfer. Transfer-in EVT cases increased from 256 in Q1 2012 to 1,422 in Q4 2017, with sharply accelerated increases following Q4 2014 (p<0.001 for change in linear trend)...