Division of Cardiology, Doylestown Health, Doylestown Hospital, Doylestown, Pennsylvania.
Division of Neurology, Doylestown Health, Doylestown Hospital, Doylestown, Pennsylvania.
JACC Cardiovasc Interv. 2020 Apr 13;13(7):884-891. doi: 10.1016/j.jcin.2020.01.232.
The aim of this study was to determine the feasibility of establishing a mechanical thrombectomy (MT) program for acute ischemic stroke in a community hospital using interventional cardiologists working closely with neurologists.
American Heart Association/American Stroke Association 2018 guidelines give a Class I (Level of Evidence: A) recommendation for MT in eligible patients with large vessel occlusion stroke. Improvement in neurological outcomes with MT is highly time sensitive. Most hospitals do not have trained neurointerventionalists to perform MT, leading to treatment delays that reduce the benefit of reperfusion therapy.
An MT program based in the cardiac catheterization laboratory was developed using interventional cardiologists with ST-segment elevation myocardial infarction teams.
Forty patients underwent attempted MT for acute ischemic stroke. An additional 5 patients who underwent angiography did not undergo attempted thrombectomy, because of absence of target thrombus (n = 4) or unsuitable anatomy (n = 1). Median National Institutes of Health Stroke Scale score prior to MT was 19 and at discharge was 7. TICI (Thrombolysis In Cerebral Infarction) grade 2b or 3 flow was restored in 80% of patients (32 of 40). At 90 days, 55% of patients (22 of 40) were functionally independent (modified Rankin score ≤2). In-hospital mortality was 13% (5 of 40). Symptomatic intracranial hemorrhage occurred in 15% of patients (6 of 40). Major vascular complications occurred in 5% of patients (2 of 40).
MT can be successfully performed by interventional cardiologists with carotid stenting experience working closely with neurologists in hospitals lacking formally trained neurointerventionists. This model has the potential to increase access to timely care for patients with acute ischemic stroke.
本研究旨在探讨在一家社区医院中，由心脏介入医师与神经科医生密切合作，利用机械取栓术（MT）治疗急性缺血性脑卒中的可行性。
美国心脏协会/美国中风协会 2018 年指南推荐对符合条件的大血管闭塞性脑卒中患者进行 MT（I 类，A级证据）。MT 可显著改善神经功能结局，但对时间非常敏感。大多数医院没有接受过 MT 培训的神经介入医师，导致治疗延误，降低了再灌注治疗的获益。
在心脏介入医师与 ST 段抬高型心肌梗死团队的基础上建立了 MT 项目。
40 例急性缺血性脑卒中患者接受了 MT 治疗。另外 5 例行血管造影的患者因未发现目标血栓（n=4）或不适合进行 MT（n=1）而未进行 MT。MT 前的国立卫生研究院卒中量表评分中位数为 19，出院时为 7。80%（32/40）的患者恢复了 TICI（血栓切除术治疗脑梗死）2b 级或 3 级血流。90 天时，40 例患者中有 55%（22/40）功能独立（改良 Rankin 评分≤2）。住院死亡率为 13%（5/40）。15%的患者（6/40）发生症状性颅内出血。5%的患者（2/40）发生重大血管并发症。
有颈动脉支架置入术经验的心脏介入医师与缺乏正规神经介入培训的神经科医生密切合作，可以成功实施 MT。该模式有可能增加急性缺血性脑卒中患者获得及时治疗的机会。
