Bücke Philipp, Pérez Marta Aguilar, Schmid Elisabeth, Nolte Christian H, Bäzner Hansjörg, Henkes Hans
Neurological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstr. 60-62, 70174, Stuttgart, Germany.
Neuroradiological Clinic, Neurocenter, Klinikum Stuttgart, Kriegsbergstr. 60-62, 70174, Stuttgart, Germany.
Clin Neuroradiol. 2018 Jun;28(2):235-244. doi: 10.1007/s00062-017-0558-z. Epub 2017 Jan 31.
Endovascular mechanical thrombectomy (mTE) in acute ischemic stroke due to large cerebral artery occlusion is effective and safe. The procedure is currently offered by specialized hospitals. Physicians from smaller hospitals need to refer patients to stroke centers. Secondary referrals involve delays for transportation. Little is known about effects of distant referrals on outcome and complications as compared to direct admittance.
To evaluate the effects of referral patterns on outcome and safety, we analyzed 941 patients with anterior circulation stroke receiving mTE between January 2010 and December 2015. Patients were divided into three groups: directly admitted patients (DAP), inner-city transfers (ICT) and long-distance referrals (LDR). We assessed (1) procedural parameters (2) frequency of good functional outcome (mRS ≤2 at 3 months) and (3) mortality rates.
Referrals had a significantly longer imaging-to-groin time compared to DAP (median 150 min vs. 85 min, p <0.001), the same was true for LDR vs. ICT (median 157 min vs. 133.5 min, p <0.001). Time to recanalization was significantly longer for referrals compared to DAP (median 348 min vs. 260 min, p <0.001). There was no significant difference in the frequency of good functional outcome (DAP 39.5%, ICT 35.1%, LDR 37.0%; p =0.709), all-cause mortality at day 90 (DAP 31.5%, ICT 23.0%, LDR 27.0%; p =0.212) and the rate of symptomatic intracranial hemorrhage (p =0.834).
Timing remains a critical factor in acute ischemic stroke treatment by endovascular means. Long distance referral to specialized neurovascular centers with high recanalization rates, however, does allow for a good functional outcome in a significant number of patients.
血管内机械取栓术（mTE）治疗大脑中动脉闭塞所致急性缺血性卒中有效且安全。目前该手术仅由专科医院开展。小型医院的医生需要将患者转诊至卒中中心。二次转诊会导致转运延迟。与直接入院相比，远距离转诊对治疗结果和并发症的影响鲜为人知。
为评估转诊模式对治疗结果和安全性的影响，我们分析了2010年1月至2015年12月期间接受mTE治疗的941例前循环卒中患者。患者分为三组：直接入院患者（DAP）、市内转诊患者（ICT）和远距离转诊患者（LDR）。我们评估了（1）手术参数（2）良好功能预后（3个月时mRS≤2）的频率以及（3）死亡率。
与DAP相比，转诊患者的影像学检查至腹股沟穿刺时间明显更长（中位数150分钟对85分钟，p<0.001），LDR与ICT相比也是如此（中位数157分钟对133.5分钟，p<0.001）。与DAP相比，转诊患者的再通时间明显更长（中位数348分钟对260分钟，p<0.001）。良好功能预后的频率（DAP为39.5%，ICT为35.1%，LDR为37.0%；p=0.709）、90天时的全因死亡率（DAP为31.5%，ICT为23.0%，LDR为27.0%；p=0.212）和症状性颅内出血发生率（p=0.834）无显著差异。
时间仍是血管内治疗急性缺血性卒中的关键因素。然而，转诊至再通率高的专业神经血管中心，仍能使相当一部分患者获得良好的功能预后。
