Suzuki Shuichi, Saver Jeffrey L, Scott Phillip, Jahan Reza, Duckwiler Gary, Starkman Sidney, Su Yafang, Kidwell Chelsea S
Department of Radiological Sciences, UCLA School of Medicine, 10833 Le Conte Ave, room B2-188 CHS, Los Angeles, CA 90095-1721, USA.
AJNR Am J Neuroradiol. 2004 Nov-Dec;25(10):1802-6.
Intra-arterial therapies for ischemic stroke offer promise as a means to extend the time window for acute treatment. The purpose of this study was to identify the percentage of the US population with potential access to interventional neuroradiologic expertise within 6 hours of the onset of stroke symptoms.
Hospital locations of interventional neuroradiologists were identified from the 2002 roster of the American Society of Interventional and Therapeutic Neuroradiology. Data for populations in surrounding regions were extracted from US Census 2001 data by zip code. Standard transport speeds for emergency medical services were used in our estimates of the population living within a 5-hour transport time, which was a 6-hour treatment window less a 1-hour door-to-needle time, resulting in a 200-mile radius. A 2-hour transport time, or 3-hour treatment window, reflected a 65-mile radius.
A total of 385 interventional neuroradiologists were identified, practicing in 45 states. With a 200-mile radius, 99% of the total US population had access to neurointerventional treatment within 6 hours of symptom onset. With a 65-mile radius, 82% of the population had access within 3 hours of symptom onset. Alaska and the Mid-Northwest region covering Idaho, Wyoming, North Dakota, and South Dakota had limited coverage.
Most of the US population has access to interventional neuroradiologic expertise for acute stroke therapy. These data suggest that interventional therapies that extend the time window for treating acute ischemic stroke could have a major effect on public health and merit further research development and investment.
缺血性卒中的动脉内治疗有望成为延长急性治疗时间窗的一种手段。本研究的目的是确定在美国，卒中症状发作后6小时内有机会获得介入神经放射学专业治疗的人群比例。
从美国介入与治疗神经放射学会2002年的名册中确定介入神经放射科医生的医院位置。周边地区人群的数据通过邮政编码从2001年美国人口普查数据中提取。在我们对居住在5小时交通时间内的人群估计中，使用了紧急医疗服务的标准运输速度，这是一个6小时的治疗窗口减去1小时的门到针时间，从而得出半径为200英里。2小时的交通时间，即3小时的治疗窗口，反映的半径为65英里。
共确定了385名介入神经放射科医生，分布在45个州。半径为200英里时，99%的美国总人口在症状发作后6小时内可获得神经介入治疗。半径为65英里时，82%的人口在症状发作后3小时内可获得治疗。阿拉斯加以及包括爱达荷州、怀俄明州、北达科他州和南达科他州的中西北地区覆盖范围有限。
美国大部分人口可获得急性卒中治疗的介入神经放射学专业治疗。这些数据表明，延长急性缺血性卒中治疗时间窗的介入治疗可能对公众健康产生重大影响，值得进一步研究开发和投资。
