Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland.
Interventional Neuroradiology Service, Department of Radiology, Beaumont Hospital, Dublin, Ireland.
Clin Radiol. 2019 Dec;74(12):950-955. doi: 10.1016/j.crad.2019.07.021. Epub 2019 Sep 11.
To determine the experience of a regional stroke referral centre of external referrals for endovascular thrombectomy (EVT) in patients with symptoms of acute ischaemic stroke (AIS) and large vessel occlusion (LVO).
Data were collected prospectively over two 4-month periods (2017-2018) on consecutive external referrals for EVT. Baseline demographics, imaging findings, and key time parameters were recorded. Reasons for not transferring patients and for not performing EVT were recorded. Key time intervals were calculated and compared between the transferred and non-transferred group with and without intracranial occlusion and between the transferred patients who underwent thrombectomy and those who did not.
Two hundred and sixty-two patients were referred. Sixty-one percent (n=159) were accepted and transferred for treatment. Of those transferred, 86% (n=136) had EVT. Fourteen percent (n=23) were unsuitable for EVT on arrival due to no vessel occlusion (48% n=11), poor Alberta Stroke Program Early CT Score (ASPECTS)/established infarct (30%, n=7) haemorrhage (9%, n=2), and clinical recovery (13% n=3). One hundred and three patients (39%) were ineligible for EVT following phone discussion due to absence of intracranial occlusion (59%, n=61), low ASPECTS (22%, n=23), distal occlusion (4%, n=4), low/improving National Institutes of Health Stroke Scale (NIHSS; 10.7%, n=11), and poor modified Rankin Scale (mRS) at baseline (3%, n=3). Patients with LVO but not transferred had longer onset to hospital arrival time compared with those transferred 151.5 versus 91 minutes (p<0.005), with a trend also toward a longer door to CT/CTA 40 minutes versus 30 minutes (p=0.142).
These data provide valuable insights into the service provision of a comprehensive stroke network. The present rates of EVT and futile transfers are modest compared to published data. Access to neuroradiology and specialised stroke assessment is crucial to optimise time to treatment.
确定一个区域卒中转诊中心对急性缺血性卒中（AIS）和大血管闭塞（LVO）患者的血管内血栓切除术（EVT）的外转经验。
在两个 4 个月的时间段（2017-2018 年），前瞻性收集了连续的 EVT 外转患者的数据。记录了基线人口统计学、影像学发现和关键时间参数。记录了未转患者和未行 EVT 的原因。计算并比较了有和无颅内闭塞以及行和未行血栓切除术的转患者之间的关键时间间隔。
共转介了 262 例患者。61%（n=159）接受并转介治疗。在转患者中，86%（n=136）行 EVT。14%（n=23）由于无血管闭塞（48%，n=11）、早期 CT 评分（ASPECTS）/已有梗死（30%，n=7）出血（9%，n=2）和临床恢复（13%，n=3）不佳，在到达时不适合 EVT。103 例（39%）经电话讨论后因颅内无闭塞（59%，n=61）、ASPECTS 低（22%，n=23）、远段闭塞（4%，n=4）、国立卫生研究院卒中量表（NIHSS）低/改善（10.7%，n=11）和基线改良 Rankin 量表（mRS）差（3%，n=3）而不适合 EVT。与转患者相比，LVO 但未转患者的发病至医院到达时间更长，分别为 151.5 分钟和 91 分钟（p<0.005），门到 CT/CTA 时间也有延长趋势，分别为 40 分钟和 30 分钟（p=0.142）。
这些数据提供了有关综合卒中网络服务提供的宝贵见解。与已发表的数据相比，目前的 EVT 和无效转的比例适中。获得神经放射学和专门的卒中评估对于优化治疗时间至关重要。
