ABSTRACT NUMBER: ESOC2026A37 METROPOLITAN STROKE NETWORK ANALYSIS SHOWS SURVIVAL BENEFIT OF DIRECT TRANSFER FOR COMBINED THROMBOLYSIS AND THROMBECTOMY

Abstract Background and aims The optimal prehospital transport strategy for patients eligible for mechanical thrombectomy remains debated. We evaluated how direct versus secondary transfer to a comprehensive stroke centre (CSC) influences outcomes in a large metropolitan stroke network. Methods This prospective registry-based cohort included all patients undergoing thrombectomy between 2015 and 2022 in a city of 1.7 million inhabitants. The network comprised 11 primary stroke centres (PSC) referring to a single CSC, all reachable within 60 minutes. Among 2,017 patients, 242 (12%) were transported directly to the CSC and 1,775 (88%) were secondarily transferred after initial assessment at a PSC. Functional outcome was measured by the modified Rankin Scale (mRS) at 90 days. Multivariable logistic and Cox regression models identified independent predictors of good outcome and survival. Results Median onset-to-CSC-admission time was shorter after direct versus secondary transfer (101 [7–1,071] vs. 240 [40–1,411] min, p < 0.0001). Good functional outcome (mRS 0–2) was more frequent after direct transport (50.3% vs. 40.4%, p = 0.015). After adjustment for age, NIHSS, thrombolysis, posterior circulation, and comorbidities, direct transport independently predicted good outcome (OR 1.74, 95% CI 1.25–2.42; p = 0.001). Among patients receiving combined thrombolysis and thrombectomy (n = 1,015), direct transport was associated with better long-term survival (log-rank p = 0.019; adjusted HR 0.67, 95% CI 0.47–0.95; p = 0.026). Conclusions Even within a one-hour-access metropolitan network, direct transport to a CSC shortens delays, improves functional recovery, and enhances survival among patients undergoing combined reperfusion therapy. Conflict of interest Sándor Nardai: Nothing to Disclose