A Regional Network Organization for Thrombectomy for Acute Ischemic Stroke in the Anterior Circulation; Timing, Safety, and Effectiveness.
Aged
Brain Infarction
/ diagnosis
Delivery of Health Care, Integrated
/ organization & administration
Disability Evaluation
Feasibility Studies
Female
Fibrinolytic Agents
/ administration & dosage
Humans
Infusions, Intravenous
Male
Mechanical Thrombolysis
/ adverse effects
Middle Aged
Patient Transfer
/ organization & administration
Recovery of Function
Regional Health Planning
/ organization & administration
Retrospective Studies
Risk Factors
Thrombectomy
/ adverse effects
Time Factors
Time-to-Treatment
/ organization & administration
Treatment Outcome
Acute ischemic stroke
endovascular treatment
outcome.
srip-and-ship
thrombolysis
Journal
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
ISSN: 1532-8511
Titre abrégé: J Stroke Cerebrovasc Dis
Pays: United States
ID NLM: 9111633
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
received:
03
08
2018
revised:
19
09
2018
accepted:
27
09
2018
pubmed:
18
11
2018
medline:
29
1
2019
entrez:
17
11
2018
Statut:
ppublish
Résumé
Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship). We retrospectively analyzed 179 consecutive patients (93 in the mothership group and 86 in the drip-and-ship group), with AIS secondary to LVO in the anterior cerebral circulation and a clinical-radiological mismatch (NIHSS ≥ 8 and DWI-ASPECT score ≥5), up to 6 hours after symptoms onset. We evaluated 3-month functional modified Rankin scale (mRS), periprocedural time management, mortality, and symptomatic intracranial haemorrhage (sICH). Despite significant longer process time in the drip-and-ship group, mRS ≤ 2 at 3 months (39.8% versus 44.1%, P = .562), Thrombolysis in cerebral infarction 2b-3 (85% versus 78%, P = .256), and sICH (7.0% versus 9.7%, P = .515) were similar in both group regardless of baseline clinical or radiological characteristics. After multivariate logistic regression, the predictive factors for favorable outcome were age (odds ratio [OR] Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC.
Sections du résumé
BACKGROUND
BACKGROUND
Mechanical thrombectomy (MT) in association with intravenous thrombolysis is recommended for treatment of acute ischemic stroke (AIS), with large vessel occlusion (LVO) in the anterior circulation. Because MT is only available in comprehensive stroke centers (CSC), the challenge of stroke organization is to ensure equitable access to the fastest endovascular suite. Our aim was to evaluate the feasibility, efficacy, and safety of MT in patients initially managed in 1 CSC (mothership), compared with patients first managed in primary stroke center (PSC), and then transferred to the CSC for MT (drip-and-ship).
METHODS
METHODS
We retrospectively analyzed 179 consecutive patients (93 in the mothership group and 86 in the drip-and-ship group), with AIS secondary to LVO in the anterior cerebral circulation and a clinical-radiological mismatch (NIHSS ≥ 8 and DWI-ASPECT score ≥5), up to 6 hours after symptoms onset. We evaluated 3-month functional modified Rankin scale (mRS), periprocedural time management, mortality, and symptomatic intracranial haemorrhage (sICH).
RESULTS
RESULTS
Despite significant longer process time in the drip-and-ship group, mRS ≤ 2 at 3 months (39.8% versus 44.1%, P = .562), Thrombolysis in cerebral infarction 2b-3 (85% versus 78%, P = .256), and sICH (7.0% versus 9.7%, P = .515) were similar in both group regardless of baseline clinical or radiological characteristics. After multivariate logistic regression, the predictive factors for favorable outcome were age (odds ratio [OR]
CONCLUSIONS
CONCLUSIONS
Our study showed encouraging results from a regional protocol of MT comparing patients transferred from PSC or brought directly in CSC.
Identifiants
pubmed: 30442556
pii: S1052-3057(18)30573-1
doi: 10.1016/j.jstrokecerebrovasdis.2018.09.051
pii:
doi:
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
259-266Informations de copyright
Copyright © 2018. Published by Elsevier Inc.