Direct Admission vs. Secondary Transfer to a Comprehensive Stroke Center for Thrombectomy

Retrospective Analysis of a Regional Stroke Registry with 2797 Patients
  • Fatih Seker
  • Susanne Bonekamp
  • Susanne Rode
  • Sonja Hyrenbach
  • Martin Bendszus
  • Markus A. MöhlenbruchEmail author
Original Article


Background and Purpose

This study aimed at comparing short-term clinical outcome after thrombectomy in patients directly admitted (DA) to a comprehensive stroke center with patients secondarily transferred (ST) from a primary stroke center.


In a prospective regional stroke registry, all stroke patients with a premorbid modified Rankin scale (mRS) score 0–2 who were admitted within 24 h after stroke onset and treated with thrombectomy between 2014 and 2017 were retrospectively analyzed. Patients with DA and ST were compared regarding the proportion of good outcome (discharge mRS 0–2), median discharge mRS, mRS shift (difference between premorbid mRS and mRS on discharge) and occurrence of symptomatic intracranial hemorrhage.


Out of 2797 patients, 1051 (37.6%) achieved good clinical outcome. In the DA group (n = 1657), proportion of good outcome was higher (DA 42.2% vs. ST 30.9%, P < 0.001) and median discharge mRS (DA 3 vs. ST 4, P < 0.001) and median mRS shift (DA 3 vs. ST 4, P < 0.001) were lower. The rate of symptomatic intracranial hemorrhage was similar in both groups (DA 9.3% vs. ST 7.5%, P = 0.101). Multivariate analysis revealed that direct admission was an independent predictor of good clinical outcome (adjusted odds ratio, OR 1.32, confidence interval, CI 1.09–1.60, P = 0.004).


These results confirm prior studies stating that DA to a comprehensive stroke center leads to better outcome compared to ST in stroke patients undergoing thrombectomy.


Mothership Drip and Ship Triage Regional stroke care Interhospital transfer 



Comprehensive stroke center


Direct admission


Endovascular thrombectomy


Intravenous thrombolysis


Secondary transfer


Author Contribution

F. Seker, S. Bonekamp, M. Bendszus and M.A. Möhlenbruch conceived the study and initiated the study design. S. Hyrenbach and S. Rode contributed to acquisition of data. F. Seker, M. Bendszus and M.A. Möhlenbruch contributed to analysis and interpretation of data. All authors contributed to refinement of the study protocol and reviewed and approved the final manuscript.

Conflict of interest

F. Seker, S. Bonekamp, S. Rode, S. Hyrenbach, M. Bendszus and M.A. Möhlenbruch declare that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeuroradiologyHeidelberg University HospitalHeidelbergGermany
  2. 2.Qualitätssicherung im Gesundheitswesen Baden-Württemberg GmbHStuttgartGermany

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