Aoki Junya, Suzuki Kentaro, Kanamaru Takuya, Katano Takehiro, Kutsuna Akihito, Kimura Kazumi
Department of Neurology, Nippon Medical School, Japan.
Rinsho Shinkeigaku. 2020 Apr 24;60(4):289-292. doi: 10.5692/clinicalneurol.cn-001366. Epub 2020 Mar 31.
Door to groin puncture time is one of the determinants of clinical outcome in patients treated with endovascular thrombectomy (EVT). We have recently initiated a protocol, direct transfer to angiographic site, for patients transferred from outside hospitals. In this retrospective study, we investigated whether our new protocol had succeeded in shortening the door to groin puncture time. Data on consecutive patients with an occlusion at internal carotid artery or middle cerebral artery treated with EVT transferred from outside hospital between July 2012 and December 2018 were studied. Good outcome was defined as modified Rankin Scale score (mRS) ≤1 at 3 months. Forty (46%) patients were directly transferred to angiographic suite, 27 (19%) were indirectly transferred after CT, and 20 (23%) were after MRI. Onset to admission time was similar among the 3 groups (P = 0.711), while door to groin puncture time was significantly shorter in patients directly transferred to angiographic suite compared to those after CT as well as MRI (median 22 [25%-75%, 16-31] minutes vs. 31 [27-40], vs. 84 [58-124], P < 0.001). The rates of reperfusion with ≥ Thrombolysis in Cerebral Infarction 2b were similar among the 3 groups (88% vs. 85% vs. 90%, P = 0.886). The incidences of symptomatic intracerebral hemorrhage were also similar as 8% vs. 4% vs. 5% (P = 0.796). At 3 months after stroke, 16 (40%) patients in the 11 (41%) in those after CT, and 9 (45%) in those after MRI had the good outcome (P = 0.931). Direct transfer to angiography suite can shorten the onset to groin puncture time with safety.
从入院到股动脉穿刺的时间是血管内血栓切除术（EVT）治疗患者临床结局的决定因素之一。我们最近启动了一项针对从外院转来患者的方案，即直接转运至血管造影地点。在这项回顾性研究中，我们调查了我们的新方案是否成功缩短了从入院到股动脉穿刺的时间。研究了2012年7月至2018年12月期间从外院转来接受EVT治疗的颈内动脉或大脑中动脉闭塞的连续患者的数据。良好结局定义为3个月时改良Rankin量表评分（mRS）≤1。40例（46%）患者直接转运至血管造影室，27例（19%）在CT检查后间接转运，20例（23%）在MRI检查后转运。三组患者从发病到入院的时间相似（P = 0.711），而直接转运至血管造影室的患者从入院到股动脉穿刺的时间明显短于CT检查后以及MRI检查后的患者（中位数22 [25%-75%，16-31]分钟 vs. 31 [27-40]分钟，vs. 84 [58-124]分钟，P < 0.001）。三组中脑梗死溶栓分级≥2b级的再灌注率相似（88% vs. 85% vs. 90%，P = 0.886）。症状性脑出血的发生率也相似，分别为8% vs. 4% vs. 5%（P = 0.796）。在卒中后3个月，直接转运组16例（40%）患者、CT检查后组11例（41%）患者以及MRI检查后组9例（45%）患者获得良好结局（P = 0.931）。直接转运至血管造影室可安全地缩短从发病到股动脉穿刺的时间。
