1 Neurology Department, Centre Hospitalier de Perpignan, Perpignan, France.
2 Radiology Department, Centre Hospitalier de Perpignan, Perpignan, France.
Int J Stroke. 2017 Jul;12(5):519-523. doi: 10.1177/1747493017701151. Epub 2017 Apr 4.
Background No comprehensive study exists about mechanical thrombectomy accessibility for patients admitted to a primary stroke center without onsite interventional neuroradiology service. Aims To evaluate mechanical thrombectomy accessibility within 6 h after transfer from a primary stroke center to a distant (156 km apart; 1.5 h by car) comprehensive stroke center. Methods Analysis of data collected in a three-year prospective registry on patients admitted to a primary stroke center within 4.5 h after symptom onset and selected for transfer to a comprehensive stroke center for mechanical thrombectomy. Eligible patients had confirmed proximal arterial occlusion and no large cerebral infarction on MRI images (DWI-ASPECTS ≥ 5). The rate of transfer, transfer without mechanical thrombectomy, mechanical thrombectomy, reperfusion (TICI score ≥ 2b-3), and the main relevant time measures were determined. Results Among the 385 patients selected for intravenous thrombolysis and/or potential mechanical thrombectomy, 211 were considered as transferrable for mechanical thrombectomy. The rate of transfer was 56.4% (n = 119/211), transfer without mechanical thrombectomy 56.3% (n = 67/119), mechanical thrombectomy 24.6% (n = 52/211), and reperfusion by MT (TICI score 2b/3) 18% (n = 38/211). The relevant median times (interquartile range) were: 130 min (62) for intravenous thrombolysis start to comprehensive stroke center door, 95 minutes (39) for primary stroke center door-out to comprehensive stroke center door-in, 191 min (44) for intravenous thrombolysis start to mechanical thrombectomy puncture, 354 min (107) for symptom onset to mechanical thrombectomy puncture and 417 min (124) for symptom onset to recanalization. Conclusions Our study suggests that transfer to a distant comprehensive stroke center is associated with reduced access to early mechanical thrombectomy in patients with acute ischemic stroke and large artery occlusion. These results could be translated to other high volume distant primary stroke center.
目前尚无研究综合评估初级卒中中心无院内介入神经放射服务时，患者接受机械取栓的可及性。目的：评估从初级卒中中心转至距离 156km（车程 1.5 小时）远的综合性卒中中心后 6 小时内进行机械取栓的可及性。方法：对一项前瞻性登记研究 3 年内入组的发病 4.5 小时内至初级卒中中心就诊并选择转至综合性卒中中心行机械取栓的患者进行数据分析。纳入患者符合近端动脉闭塞和 MRI 图像无大面积脑梗死（DWI-ASPECTS≥5）标准。评估转院率、未行机械取栓转院率、行机械取栓率、再通率（TICI 评分≥2b-3）以及主要相关时间指标。结果：在 385 例接受静脉溶栓和/或可能机械取栓的患者中，211 例患者被认为适合行机械取栓。转院率为 56.4%（119/211），未行机械取栓转院率为 56.3%（67/119），行机械取栓率为 24.6%（52/211），机械取栓再通率（TICI 评分 2b/3）为 18%（38/211）。相关中位数时间（四分位距）如下：从静脉溶栓开始至综合性卒中中心的时间为 130 分钟（62），从初级卒中中心门到综合性卒中中心门的时间为 95 分钟（39），从静脉溶栓开始至机械取栓穿刺的时间为 191 分钟（44），从症状发作至机械取栓穿刺的时间为 354 分钟（107），从症状发作至再通的时间为 417 分钟（124）。结论：本研究表明，对于急性缺血性卒中和大血管闭塞患者，转至距离较远的综合性卒中中心与早期机械取栓的可及性降低相关。这些结果可能适用于其他高容量的远距离初级卒中中心。
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