Uchiyama Naoyuki, Misaki Kouichi, Mohri Masanao, Kamide Tomoya, Hirota Yuichi, Higashi Ryo, Minamide Hisato, Kohda Yukihiko, Asahi Takashi, Shoin Katsuo, Iwato Masayuki, Kita Daisuke, Hamada Yoshitaka, Yoshida Yuya, Nakada Mitsutoshi
Department of Neurosurgery, Kanazawa University Hospital.
Neurol Med Chir (Tokyo). 2016 Dec 15;56(12):737-744. doi: 10.2176/nmc.oa.2016-0101. Epub 2016 Oct 11.
Five recent multicenter randomized controlled trials (RCTs) have clearly shown the superiority of mechanical thrombectomy in large vessel occlusion acute ischemic stroke compared to systemic thrombolysis. Although 14 hospitals in Ishikawa prefecture have uninterrupted availability of systemic thrombolysis, mechanical thrombectomy is not available at all of these hospitals. Therefore, we established a Kanazawa mobile embolectomy team (KMET), which could travel to these hospitals and perform the acute reperfusion therapy. In this article, we report early treatment outcomes and validate the effectiveness of a network between affiliated hospitals and KMET. Between January 2014 and December 2015, 48 patients, aged 45-92 years (mean: 73.0 years), underwent acute reperfusion therapy provided by KMET in 10 affiliated hospitals of Kanazawa University Hospital. The pre-treatment NIHSS scores ranged from 5 to 39 (mean: 19.1). ASPECTS+W ranged from 1 to 11 (mean: 7.3). Successful revascularization, defined as thrombolysis in cerebral infarction (TICI) 2b or 3, was achieved in 38/48 cases (80%), and a good outcome, defined as modified Rankin Scale (mRS) score from 0 to 2 at 90 days after the treatment, was achieved in 24/48 cases (50%). There were two cases of intracranial bleeding (4%). Mean time from onset to recanalization was 297 min. These results, which are similar to those of five previous RCTs, suggest that a collaborative network between affiliated hospitals and KMET is effective for acute reperfusion therapy in local areas wherein experienced neuroendovascular specialists are insufficient.
最近的五项多中心随机对照试验（RCT）清楚地表明，与全身溶栓相比，机械取栓术在治疗大血管闭塞急性缺血性卒中方面具有优越性。虽然石川县的14家医院均可不间断地提供全身溶栓治疗，但并非所有这些医院都能进行机械取栓术。因此，我们成立了金泽移动取栓团队（KMET），该团队可以前往这些医院并实施急性再灌注治疗。在本文中，我们报告了早期治疗结果，并验证了附属医院与KMET之间网络的有效性。在2014年1月至2015年12月期间，48例年龄在45 - 92岁（平均73.0岁）的患者在金泽大学医院的10家附属医院接受了KMET提供的急性再灌注治疗。治疗前美国国立卫生研究院卒中量表（NIHSS）评分范围为5至39分（平均19.1分）。脑梗死溶栓（ASPECTS）+W评分范围为1至11分（平均7.3分）。38/48例（80%）实现了成功再灌注，定义为脑梗死溶栓（TICI）2b或3级；24/48例（50%）在治疗后90天获得了良好预后，定义为改良Rankin量表（mRS）评分为0至2分。有2例颅内出血（4%）。从发病到再通的平均时间为297分钟。这些结果与之前五项RCT的结果相似，表明附属医院与KMET之间的协作网络对于当地缺乏经验丰富的神经血管介入专家的急性再灌注治疗是有效的。
