Kabra Ruchi, Phillips Timothy J, Saw Jacqui-Lyn, Phatouros Constantine C, Singh Tejinder P, Hankey Graeme J, Blacker David, Ghia Darshan, Prentice David, McAuliffe William
Neurological Intervention and Imaging Service of Western Australia (NIISWA), Perth, Western Australia, Australia.
Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia.
J Neurointerv Surg. 2017 Jun;9(6):535-540. doi: 10.1136/neurintsurg-2016-012304. Epub 2016 May 9.
To audit our institutional mechanical thrombectomy (MT) outcomes for acute anterior circulation stroke and examine the influence of workflow time metrics on patient outcomes.
A database of 100 MT cases was maintained throughout May 2010-February 2015 as part of a statewide service provided across two tertiary hospitals (H1 and H2). Patient demographics, stroke and procedural details, blinded angiographic outcomes, and 90-day modified Rankin Scale (mRS) scores were recorded. The following time points in stroke treatment were recorded: stroke onset, hospital presentation, CT imaging, arteriotomy, and recanalization. Statistical analysis of outcomes, predictors of outcome, and differences between the hospitals was carried out.
Thrombolysis in Cerebral Infarction (TICI) 2b/3 reperfusion was 79%. Forty-nine per cent of patients had good clinical outcomes (mRS 0-2). In a subgroup analysis of 76 patients with premorbid mRS 0-1 and first CT performed ≤4.5 h after stroke onset, 60% had good clinical outcomes. Patient and disease characteristics were matched between the two hospitals. H1 had shorter times between hospital presentation and CT (32 vs 55 min, p=0.01), CT and arteriotomy (33 vs 69 min, p=0.00), and stroke onset and recanalization (198 vs 260 min, p=0.00). These time metrics independently predicted good clinical outcome. Median days spent at home in the first 90 days was greater at H1 (61 vs 8, p=0.04) than at H2. A greater proportion of patients treated at H1 were independent (mRS 0-2) at 90 days (54% vs 42%); however, this was not statistically significant (p=0.22).
Outcomes similar to randomized controlled trials are attainable in 'real-world' settings. Workflow time metrics were independent predictors of clinical outcome, and differed between the two hospitals owing to site-specific organizational differences.
审核我院急性前循环卒中的机械取栓（MT）治疗效果，并探讨工作流程时间指标对患者预后的影响。
作为在两家三级医院（H1和H2）提供的全州范围服务的一部分，在2010年5月至2015年2月期间维护了一个包含100例MT病例的数据库。记录患者的人口统计学资料、卒中及手术细节、盲法血管造影结果以及90天改良Rankin量表（mRS）评分。记录卒中治疗过程中的以下时间点：卒中发作、入院、CT成像、动脉切开和再通。对治疗效果、预后预测因素以及两家医院之间的差异进行了统计分析。
脑梗死溶栓（TICI）2b/3级再灌注率为79%。49%的患者获得了良好临床预后（mRS 0 - 2）。在对76例病前mRS 0 - 1且卒中发作后首次CT检查≤4.5小时的患者进行的亚组分析中，60%的患者获得了良好临床预后。两家医院的患者和疾病特征相匹配。H1在入院与CT检查之间的时间（32分钟对55分钟，p = 0.01）、CT检查与动脉切开之间的时间（33分钟对69分钟，p = 0.00）以及卒中发作与再通之间的时间（198分钟对260分钟，p = 0.00）更短。这些时间指标独立预测了良好的临床预后。H1患者在最初90天在家度过的中位数天数（61天对8天，p = 0.04）比H2更多。在H1接受治疗的患者在90天时独立（mRS 0 - 2）的比例更高（54%对42%）；然而，这在统计学上无显著差异（p = 0.22）。
在“真实世界”环境中可获得与随机对照试验相似的治疗效果。工作流程时间指标是临床预后的独立预测因素，且由于特定地点的组织差异，两家医院之间存在不同。
