Neurology, Nippon Medical School, Tokyo, Japan
Neurology, Nippon Medical School, Tokyo, Japan.
J Neurointerv Surg. 2020 Nov;12(11):1080-1084. doi: 10.1136/neurintsurg-2019-015625. Epub 2020 Feb 12.
The feasibility of performing MRI first for patients with suspected hyperacute stroke in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-reperfusion time (DRT) in endovascular treatment (EVT) were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and to examine the effects of a quality improvement (QI) process for reducing DRT using MRI.
From January 2013 to December 2018, consecutive patients with acute stroke who came to hospital directly and were treated with emergent EVT were prospectively enrolled into the present study. In principle, MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DRT was adopted during this period. Time metrics for EVT were compared between specific time periods.
A total of 180 patients (71 women; median age 76 years (range 69-64); National Institutes of Health Stroke Scale score 17 (range 10-23)) were included in the present study. More patients in the late phase were managed with the MRI-first policy (p<0.001). DRT (199 min in Phase 1, 135 min in Phase 2, 129 min in Phase 3, and 121 min in Phase 4, p<0.001) was significantly reduced across the phases. The percentage of patients with DRT <120 min increased significantly across time periods (p<0.001). Symptomatic intracerebral hemorrhage did not increase across phases (p=0.575).
An MRI-first policy was feasible, and DRT decreased considerably with a step-by-step QI process. This process may be applicable to other hospitals.
在实际操作中，尚未充分检查对疑似超急性脑卒中患者行 MRI 检查的可行性。此外，血管内治疗（EVT）中降低门到再灌注时间（DRT）的大多数既往研究都是使用 CT 进行的。本研究旨在评估 MRI 优先策略的可行性，并研究使用 MRI 降低 DRT 的质量改进（QI）过程的效果。
从 2013 年 1 月至 2018 年 12 月，前瞻性连续纳入直接到医院就诊并接受紧急 EVT 治疗的急性脑卒中患者。原则上，对疑似急性脑卒中患者行 MRI 检查。在此期间采用了降低 DRT 的分步 QI 过程。比较了不同时间段 EVT 的时间指标。
本研究共纳入 180 例患者（71 例女性；中位年龄 76 岁（范围 69-64）；国立卫生研究院卒中量表评分 17 分（范围 10-23））。后期有更多的患者采用 MRI 优先策略进行治疗（p<0.001）。DRT（第 1 阶段 199 分钟，第 2 阶段 135 分钟，第 3 阶段 129 分钟，第 4 阶段 121 分钟，p<0.001）在各阶段显著降低。DRT<120 分钟的患者比例随时间明显增加（p<0.001）。各阶段症状性颅内出血无明显增加（p=0.575）。
MRI 优先策略是可行的，并且通过逐步的 QI 过程，DRT 显著降低。该过程可能适用于其他医院。
