Wiącek Marcin, Kaczorowski Rafał, Sieczkowski Bartosz, Kanas Natalia, Bartosik-Psujek Halina
Department of Neurology, Clinical Regional Hospital No. 2, Rzeszów, Poland.
Department of Neurology, Clinical Regional Hospital No. 2, Rzeszów, Poland.
Neurol Neurochir Pol. 2018 May-Jun;52(3):359-363. doi: 10.1016/j.pjnns.2017.12.010. Epub 2017 Dec 26.
Mechanical thrombectomy (MT) is now well-established treatment method for selected patients with acute ischemic stroke (AIS) and efforts are being made to incorporate it into the systems of stroke care. Our objective is to assess the number of AIS individuals eligible for MT in the cohort of single academic stroke center.
We retrospectively reviewed initial non-invasive vascular imaging data of AIS patients presenting within 5h of symptom onset for the presence of large vessel occlusion (LVO) over 2-year period (2015-2016). Among subjects confirmed with LVO: time-to-presentation, premorbid functional and on-admission neurological state, site of occlusion and initial imaging data were further assessed. Two sets of criteria based on recent trials and recommendations were used to determine MT eligibility. The onset-to-evaluation time limit was set to 5h allowing ≤60min procedure initiation delay.
895 patients with the final diagnosis of AIS were admitted to our stroke center as the initial treatment facility. 246 (27.5%) presented within 5h of symptom onset and had non-invasive imaging performed. Among those 102 (41.5%) had causative LVO. The number of ≤5h presenting patients eligible for MT was 51 (20.7%) when applying restrictive or 80 (32.5%) with more permissive criteria.
Among AIS patients, in whom onset-to-arrival time allowed to initiate the endovascular procedure within 6h of symptom duration, 21% were eligible for MT treatment according to more and 33% to less restrictive criteria. It accounts for about 6% and 9% of all AIS cases, respectively.
机械取栓术（MT）现已成为特定急性缺血性卒中（AIS）患者的成熟治疗方法，并且正在努力将其纳入卒中护理体系。我们的目的是评估在单一学术性卒中中心队列中符合MT治疗条件的AIS患者数量。
我们回顾性分析了在2年期间（2015 - 2016年）症状发作5小时内就诊的AIS患者的初始无创血管成像数据，以确定是否存在大血管闭塞（LVO）。在确诊为LVO的受试者中，进一步评估就诊时间、病前功能和入院时神经状态、闭塞部位以及初始成像数据。基于近期试验和建议的两套标准用于确定MT治疗的 eligibility。将发病至评估的时间限制设定为5小时，允许手术开始延迟≤60分钟。
895例最终诊断为AIS的患者作为初始治疗机构入住我们的卒中中心。246例（27.5%）在症状发作5小时内就诊并进行了无创成像。其中102例（41.5%）存在导致症状的LVO。应用严格标准时，≤5小时就诊且符合MT治疗条件的患者数量为51例（20.7%）；应用更宽松标准时为80例（32.5%）。
在症状持续时间6小时内发病至到达时间允许启动血管内手术的AIS患者中，根据更宽松和更严格标准，分别有21%和33%符合MT治疗条件。这分别占所有AIS病例的约6%和9%。
