Jagiellonian University, Poland.
The University Hospital in Cracow, Poland.
Neurol Neurochir Pol. 2017 Sep-Oct;51(5):339-346. doi: 10.1016/j.pjnns.2017.05.004. Epub 2017 Jul 5.
Mechanical thrombectomy (MT) is not reimbursed by the Polish public health system. We present a description of 5 years of experience with MT in acute stroke in Comprehensive Stroke Centers (CSCs) in Poland.
We retrospectively analyzed the results of a structured questionnaire from 23 out of 25 identified CSCs and 22 data sets that include 61 clinical, radiological and outcome measures.
Most of the CSCs (74%) were founded at University Hospitals and most (65.2%) work round the clock. In 78.3% of them, the working teams are composed of neurologists and neuro-radiologists. All CSCs perform CT and angio-CT before MT. In total 586 patients were subjected to MT and data from 531 of them were analyzed. Mean time laps from stroke onset to groin puncture was 250±99min. 90.3% of the studied patients had MT within 6h from stroke onset; 59.3% of them were treated with IV rt-PA prior to MT; 15.1% had IA rt-PA during MT and 4.7% - emergent stenting of a large vessel. M1 of MCA was occluded in 47.8% of cases. The Solitaire device was used in 53% of cases. Successful recanalization (TICI2b-TICI3) was achieved in 64.6% of cases and 53.4% of patients did not experience hemorrhagic transformation. Clinical improvement on discharge was noticed in 53.7% of cases, futile recanalization - in 30.7%, mRS of 0-2 - in 31.4% and mRS of 6 in 22% of cases.
Our results can help harmonize standards for MT in Poland according to international guidelines.
机械取栓（MT）不在波兰公共卫生系统的报销范围内。我们展示了波兰综合卒中中心（CSC）在急性卒中中进行 MT 的 5 年经验描述。
我们回顾性分析了从 25 个已识别的 CSC 中的 23 个和 22 个数据集的结构化问卷结果，这些数据集包含 61 项临床、放射学和结局测量指标。
大多数 CSC（74%）位于大学医院，大多数（65.2%）实行 24 小时工作制。其中 78.3%的团队由神经科医生和神经放射科医生组成。所有 CSC 在 MT 前都进行 CT 和血管造影 CT。共有 586 名患者接受 MT，其中 531 名患者的数据进行了分析。从卒中发病到股动脉穿刺的平均时间间隔为 250±99 分钟。90.3%的研究患者在卒中发病后 6 小时内接受 MT；59.3%的患者在 MT 前接受 IV rt-PA；15.1%的患者在 MT 期间接受 IA rt-PA，4.7%的患者进行大血管紧急支架置入。MCA M1 闭塞的病例占 47.8%。Solitaire 装置的使用比例为 53%。64.6%的病例实现了成功再通（TICI2b-TICI3），53.4%的患者没有发生出血性转化。出院时临床改善的比例为 53.7%，无效再通的比例为 30.7%，mRS 为 0-2 的比例为 31.4%，mRS 为 6 的比例为 22%。
我们的结果可以帮助根据国际指南协调波兰 MT 的标准。
