Department of Neurological Surgery, Wake Forest University, Winston-Salem, NC, USA.
Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA.
J Neurointerv Surg. 2018 Mar;10(3):235-239. doi: 10.1136/neurintsurg-2017-013147. Epub 2017 Jun 9.
There are few published data evaluating the incidence of mechanical thrombectomy among stroke centers or the times at which they occur.
A multicenter retrospective study was performed to identify all patients undergoing emergent thrombectomy for acute ischemic stroke during a 3-month period (June through August 2016). Consultations that did not undergo thrombectomy were not included.
Ten institutions participated in the study. During the 92-day study period, a total of 189 patients underwent mechanical thrombectomy. The average number of procedures per hospital over the study period was 18.9 (average of 0.2 cases per day per or 75.6 cases per year). This ranged from 0.09 cases per day at the lowest volume center to 0.49 cases per day at the highest volume center. Procedures were more common on weekdays (p<0.001) and during non-work hours (p<0.001). The most common period for thrombectomy procedures was between 20:00 and 21:00 hours. The median time from notification to groin puncture was 84 min (IQR 56-145 min) and from puncture to closure was 57 min (IQR 33-80 min). The median time from imaging completion to procedural start was 52 min longer for non-work hours than during work hours (p<0.001). There were no differences in procedural length based on day of the week or time of day.
These findings indicate that the majority of mechanical thrombectomy cases occur during non-work hours, with associated off-hours delays, which has important operational implications for hospitals implementing stroke call coverage.
很少有发表的数据评估卒中中心机械取栓的发生率，以及它们发生的时间。
一项多中心回顾性研究，旨在确定 3 个月期间（2016 年 6 月至 8 月）接受急性缺血性卒中紧急取栓的所有患者。未行取栓的会诊不包括在内。
10 家机构参与了这项研究。在 92 天的研究期间，共有 189 名患者接受了机械取栓。研究期间，每家医院的平均手术次数为 18.9（平均每天 0.2 例，每年 75.6 例）。这一数字从最低容量中心的每天 0.09 例到最高容量中心的每天 0.49 例不等。手术在工作日更为常见（p<0.001），且在非工作时间更为常见（p<0.001）。取栓手术最常见的时间段是 20:00 到 21:00 小时。从通知到腹股沟穿刺的中位数时间为 84 分钟（IQR 56-145 分钟），从穿刺到闭合的中位数时间为 57 分钟（IQR 33-80 分钟）。与工作时间相比，非工作时间影像学完成到手术开始的中位数时间延长了 52 分钟（p<0.001）。手术时间的长短与一周中的哪一天或一天中的什么时间无关。
这些发现表明，大多数机械取栓病例发生在非工作时间，相关的非工作时间延迟对实施卒中呼叫覆盖的医院具有重要的运营意义。
