Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Neurosurgery, Hokkaido Medical Center, Sapporo, Japan.
J Neurointerv Surg. 2019 Aug;11(8):757-761. doi: 10.1136/neurintsurg-2018-014296. Epub 2019 Jan 4.
Outcomes of endovascular treatment for acute ischemic stroke depend on the time interval from onset to reperfusion. Although the centralized 'mothership' method is considered preferable, the required transportation time increases the risk that a patient with a stroke may not receive intravenous or endovascular therapy. In contrast, 'drive and retrieve' describes a system wherein doctors from comprehensive stroke centers travel to primary stroke centers and provide endovascular treatment for acute ischemic stroke.
To describe the drive and retrieve system and verify the effects of this new collaboration on outcomes in patients with acute ischemic stroke among facilities.
This non-randomized, single-arm study retrospectively analyzed patients who met the inclusion criteria for endovascular treatment provided through a drive and retrieve system. Among the 122 patients treated by this system, we analyzed the time of onset to recanalization as the primary outcome. We also analyzed the efficacy of the drive and retrieve system using geographic information system analysis.
The median time from onset to recanalization was 229 min (IQR 170-307 min, 95% CI 201 to 252 min). The upper limit of the 95% CI for the time from onset to recanalization was shorter than the median times reported in two previous trials. Geographic information system analysis revealed an upward trend in the population coverage rate in each secondary medical area after the drive and retrieve method was introduced.
The drive and retrieve method may be an effective form of cooperation between facilities located within 1 hour of a comprehensive stroke center.
血管内治疗急性缺血性脑卒中的结果取决于从发病到再灌注的时间间隔。虽然集中的“母舰”方法被认为是首选，但所需的转运时间增加了中风患者可能无法接受静脉或血管内治疗的风险。相比之下，“驱车接送”描述了一种综合卒中中心的医生前往初级卒中中心为急性缺血性脑卒中患者提供血管内治疗的系统。
描述驱车接送系统，并验证这种新的合作对设施中急性缺血性脑卒中患者结局的影响。
这项非随机、单臂研究回顾性分析了符合通过驱车接送系统进行血管内治疗的纳入标准的患者。在通过该系统治疗的 122 名患者中，我们将发病至再通时间作为主要结局进行分析。我们还使用地理信息系统分析评估了驱车接送系统的疗效。
从发病到再通的中位数时间为 229 分钟（IQR 170-307 分钟，95%CI 201-252 分钟）。95%CI 上限时间从发病到再通的时间短于两项先前试验报告的中位数时间。地理信息系统分析显示，在引入驱车接送方法后，每个二级医疗区的人口覆盖范围呈上升趋势。
驱车接送方法可能是距离综合卒中中心 1 小时以内的设施之间有效的合作形式。
