The Impact of the Bypass Transport Method on Clinical Outcomes After Large Vessel Occlusion: A Pooled-Proportion Meta-Analysis

Background: Strokes are a leading cause of death worldwide, with a majority being ischemic. Treatments include intravenous thrombolytics and mechanical thrombectomy (MT) for large vessel occlusions. With both being time-sensitive, there has been a focus on emergency transport decisions; however, there is a deficit of large, multi-institutional studies to support the use of a bypass transport system where patients suspected of large vessel occlusion are transported directly to a comprehensive stroke center (CSC) even if they bypass other centers. Methods: A query was completed of PubMed, Scopus, and Web of Science for articles related to clinical outcomes with the bypass transport method. Patients directly transported to a CSC were compared to patients transferred from a peripheral stroke center. A mixed-effect meta-regression model was used to investigate the effect of patient and treatment variables on 90-day mortality and functional outcome rates. Results: Two hundred sixty articles were included in the final analysis. The time to tissue plasminogen activator treatment was insignificantly but slightly delayed in the direct group (132.1 vs. 130.6 minutes; P value: 0.8823), while the time to MT was significantly faster in the direct group (225.6 vs. 275.4 minutes; P value: 0.0114). Mortality and good neurological outcome rates were not significantly different in these groups (odds ratio = 0.7060; 95% confidence interval 0.4802–1.0379 and odds ratio = 1.1305; 95% confidence interval 0.8830–1.4473). Conclusions: This meta-analysis compares the 90-day mortality and functional outcomes between patients, and we found a statistically significant improvement in time to MT for those directly transported to a CSC; however, there was not a significant difference in clinical outcomes.