Rurality and Outcomes of Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke

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Objective: To investigate differences in outcomes among patients with acute ischemic stroke from large vessel occlusion (AIS‐LVO) transferred from rural and urban hospitals to University of Maryland Medical Center (UMMC) for mechanical thrombectomy (MT). Methods: We identified patients with AIS‐LVO transferred to UMMC for MT from July 2016 to June 2023. Primary outcome was good neurologic outcome, defined as 90‐day modified Rankin score 0–2. Multivariable logistic regression was used to identify predictors for the primary outcome. Results: We analyzed 526 patients, 233 (44%) transferred from rural hospitals in Maryland. Median NIHSS was 17 [IQR 14–20] and was similar between groups. Patients from state‐designated rural hospitals were transferred from a longer distance (difference of 57.8 km, p = 0.001), but had shorter intervals from last known well time to recanalization (difference 19 min, p = 0.24). They had similar odds of good neurologic outcome (OR 0.88, 95% CI 0.43–1.78, p = 0.72). Conclusions: Patients transferred from rural areas for MT for AIS‐LVO, at our institution, had a similar likelihood of achieving 90‐day mRS 0–2 as those transferred from urban areas.

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