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Volume 15
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10.3390/brainsci15121320
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Article

Predictors of Futile Inter-Hospital Transfer for Endovascular Thrombectomy in Anterior Circulation Acute Ischemic Stroke Due to Large Vessel Occlusion

by
Tushar B. Patil
1,
Aviraj Satish Deshmukh
2,*,
Zacharie Gagné
2,
Christine Hawkes
3,
Aris H. Katsanos
4,
Naif Faisal Alharbi
5,
Mohammed Mesfer Alwadai
5,
Rhonda McNicolle-White
6,
Mukul Sharma
4 and
Brian van Adel
6
1
Department of Neurology, Jawaharlal Nehru Medical College, Sawangi, Wardha 442005, India
2
Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
3
Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, Temerty School of Medicine, University of Toronto, Toronto, ON M5S 3H2, Canada
4
Division of Neurology, Hamilton General Hospital, McMaster University, Hamilton, ON L8S 4L8, Canada
5
Department of Neurology, King Fahd General Hospital, Ministry of Health, Jeddah 23325, Saudi Arabia
6
Department of Neurointervention, Hamilton General Hospital, McMaster University, Hamilton, ON L8S 4L8, Canada
*
Author to whom correspondence should be addressed.
Brain Sci. 2025, 15(12), 1320; https://doi.org/10.3390/brainsci15121320
Submission received: 7 November 2025 / Revised: 30 November 2025 / Accepted: 8 December 2025 / Published: 11 December 2025
(This article belongs to the Special Issue Advancements in Diagnosis and Treatment of Stroke and Cerebral Aneurysms: A Call for Innovative Research Submissions)
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Abstract

Background: Endovascular therapy (EVT) is a standard treatment for acute ischemic stroke (AIS) with large vessel occlusion (LVO), but inter-hospital transfers from primary stroke centers (PSCs) to comprehensive stroke centers (CSCs) can result in delayed treatment and worse outcomes. Up to 30–40% of patients transferred may not receive EVT. This study investigates the causes of futile transfers to a CSC in Canada, aiming to identify its predictors. Methods: We conducted a retrospective analysis of consecutive patients transferred for EVT between 1 April 2017 and 31 December 2020, from PSCs and community hospitals (CH) to a CSC in an urban area of Canada. Data on demographics, clinical characteristics, and treatment outcomes were collected. Descriptive and comparative analyses were performed to identify factors contributing to non-receipt of EVT. Results: Of the transferred 326 patients, 241 (73.9%) underwent EVT, and 85 (26%) did not. The main reasons for not performing EVT were recanalization of the target vessel (44.7%), infarct growth (29.4%), clinical improvement or low NIHSS (17.6%), and hemorrhagic transformation (8.2%). Predictors of futility were lower NIHSS at presentation, intravenous thrombolysis (IVT) at the PSC, and greater ASPECTS decay during transport. Conclusions: Our study concluded that 26% of inter-hospital transfers for EVT were futile, primarily due to infarct growth, recanalization of the target vessel, and low NIHSS. These findings suggest that closer monitoring of clinical status, consideration of direct transfers to CSCs, and enhanced triage strategies may help reduce futile transfers and improve patient outcomes.
Keywords: EVT; ischemic stroke; LVO; inter-hospital transfer; futile transfer EVT; ischemic stroke; LVO; inter-hospital transfer; futile transfer

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MDPI and ACS Style

Patil, T.B.; Deshmukh, A.S.; Gagné, Z.; Hawkes, C.; Katsanos, A.H.; Alharbi, N.F.; Alwadai, M.M.; McNicolle-White, R.; Sharma, M.; van Adel, B. Predictors of Futile Inter-Hospital Transfer for Endovascular Thrombectomy in Anterior Circulation Acute Ischemic Stroke Due to Large Vessel Occlusion. Brain Sci. 2025, 15, 1320. https://doi.org/10.3390/brainsci15121320

AMA Style

Patil TB, Deshmukh AS, Gagné Z, Hawkes C, Katsanos AH, Alharbi NF, Alwadai MM, McNicolle-White R, Sharma M, van Adel B. Predictors of Futile Inter-Hospital Transfer for Endovascular Thrombectomy in Anterior Circulation Acute Ischemic Stroke Due to Large Vessel Occlusion. Brain Sciences. 2025; 15(12):1320. https://doi.org/10.3390/brainsci15121320

Chicago/Turabian Style

Patil, Tushar B., Aviraj Satish Deshmukh, Zacharie Gagné, Christine Hawkes, Aris H. Katsanos, Naif Faisal Alharbi, Mohammed Mesfer Alwadai, Rhonda McNicolle-White, Mukul Sharma, and Brian van Adel. 2025. "Predictors of Futile Inter-Hospital Transfer for Endovascular Thrombectomy in Anterior Circulation Acute Ischemic Stroke Due to Large Vessel Occlusion" Brain Sciences 15, no. 12: 1320. https://doi.org/10.3390/brainsci15121320

APA Style

Patil, T. B., Deshmukh, A. S., Gagné, Z., Hawkes, C., Katsanos, A. H., Alharbi, N. F., Alwadai, M. M., McNicolle-White, R., Sharma, M., & van Adel, B. (2025). Predictors of Futile Inter-Hospital Transfer for Endovascular Thrombectomy in Anterior Circulation Acute Ischemic Stroke Due to Large Vessel Occlusion. Brain Sciences, 15(12), 1320. https://doi.org/10.3390/brainsci15121320

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