Lee Jin Soo, Lee Seong-Joon, Hong Ji Man, Choi Jin Wook, Hong Jeong-Ho, Chang Hyuk-Won, Kim Chang-Hyun, Kim Yong-Won, Kang Dong-Hun, Kim Yong-Sun, Ovbiagele Bruce, Demchuk Andrew M, Hwang Yang-Ha, Sohn Sung-Il
Department of Neurology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.
Department of Radiology, Ajou University School of Medicine, Ajou University Medical Center, Suwon, Korea.
Neurointervention. 2018 Mar;13(1):2-12. doi: 10.5469/neuroint.2018.13.1.2. Epub 2018 Mar 2.
The purpose of the current study is to evaluate the influence of temporal patterns related to the availability of new endovascular treatment (EVT) devices on care processes and outcomes among patients with AIS.
We enrolled 720 consecutive patients (January 2011 to May 2016) in a retrospective registry, ASIAN KR, from three Korean hospitals, who received EVT for acute ischemic stroke (AIS) caused by cervicocephalic arterial occlusions. We performed period-to-period analyses based on stent retriever reimbursement and the availability of second-generation direct-aspiration devices (Period 1: January 2011-July 2014 vs. Period 2: August 2014-May 2016); time metrics and outcomes were compared when the onset-to-puncture time was <720 min among patients with EVT for intracranial occlusion.
Period 2 had better post-EVT outcomes (3-month modified Rankin Scale 0-2 or equal to prestroke score, 48.3% vs. 60.2%, P=0.004), more successful reperfusion rates (modified Treatment In Cerebral Ischemia 2b-3, 74.2% vs. 82.2%, P=0.019), fewer subarachnoid hemorrhages (modified Fisher grade 3-4, 5.5% vs. 2.0%, P=0.034) and lower hemorrhagic transformation rates (any intracerebral hemorrhage, 35.3 vs. 22.7%, P=0.001) than Period 1. Compared to Period 1, Period 2 had a shorter door-to-puncture time (median 109 vs. 90 min, P<0.001), but longer onset-to-door time (129 vs. 143 min, P=0.057).
Recent temporal improvements in post-EVT AIS outcomes in Korea are likely due to a combination of enhanced hospital care processes and administration of newer thrombectomy devices.
本研究旨在评估与新型血管内治疗（EVT）设备可用性相关的时间模式对急性缺血性卒中（AIS）患者护理过程及预后的影响。
我们在一项回顾性注册研究ASIAN KR中纳入了720例连续患者（2011年1月至2016年5月），这些患者来自韩国的三家医院，因颈脑动脉闭塞导致急性缺血性卒中（AIS）而接受了EVT治疗。我们基于支架取栓器报销情况和第二代直接抽吸设备的可用性进行了时期间分析（时期1：2011年1月至2014年7月对比时期2：2014年8月至2016年5月）；当颅内闭塞患者接受EVT且穿刺时间<720分钟时，对时间指标和预后进行了比较。
与时期1相比，时期2的EVT后预后更好（3个月改良Rankin量表评分为0 - 2或等于卒中前评分，分别为48.3%对比60.2%，P = 0.004），再灌注成功率更高（改良脑缺血治疗2b - 3级，分别为74.2%对比82.2%，P = 0.019），蛛网膜下腔出血更少（改良Fisher分级3 - 4级，分别为5.5%对比2.0%，P = 0.034），出血转化率更低（任何脑内出血，分别为35.3对比22.7%，P = 0.001）。与时期1相比，时期2的门到穿刺时间更短（中位数109对比90分钟，P < 0.001），但发病到门时间更长（129对比143分钟，P = 0.057）。
韩国近期EVT治疗AIS后预后的时间改善可能归因于医院护理流程的强化和新型血栓切除术设备的应用。
