From the Stroke Unit, Neurology Department (M. Requena, M.O., A.G.-T., N.R.-V., M.D., J.J., S.B., M.M., J.P., D.R.-L. M. Rubiera, C.A.M., M. Ribo), Vall d'Hebron University Hospital, Barcelona, Spain.
Departament de Medicina, Universitat Autónoma de Barcelona, Spain (M. Requena, M.O., A.G.-T., J.J.,).
Stroke. 2020 Jun;51(6):1766-1771. doi: 10.1161/STROKEAHA.119.028586. Epub 2020 May 11.
Background and Purpose- Direct transfer to angiography-suite (DTAS) protocol is a promising measure to improve onset to recanalization time in patients who undergo endovascular treatment. The magnitude of the improvement of good outcome rates in function of time depends of several factors. We aim to analyze the benefit of DTAS according to time from symptom onset. Methods- Retrospective case-control study of 174 consecutive DTAS cases matched with 175 patients initially transferred to computed tomography (directly transferred to computed tomography) from February 2016 to June 2019. To obtain comparable groups on admission, cases and controls were matched by occlusion location, age (±2 years), baseline National Institutes of Health Stroke Scale score (±2 points), and time from symptoms onset to hospital arrival (±30 minutes). We analyzed the rate of good functional outcome at 3 months (modified Rankin Scale score, 0-2) and safety variables stratified in less or more than 3 hours from onset to arrive. Results- There were no significant differences regarding age, sex, or baseline National Institutes of Health Stroke Scale score. Median door-to-groin time was shorter in the DTAS patients (16 [3-21] minutes versus 70 [41.5-98.5]; <0.01). DTAS patients presented lower National Institutes of Health Stroke Scale score at 24 hours (9 [3.5-17] versus 14 [5-19]; =0.01) and a lower rate of symptomatic hemorrhagic transformation (4.6% versus 10.9%, <0.03). At 90 days, DTAS patients had a higher rate of good functional outcome (43% versus 29%; odds ratio, 1.81 [95% CI, 1.14-2.87]; =0.01). Better outcome in DTAS was observed in patients admitted in the 0 to 3 hours form onset window (n=156, odds ratio 2.63 [95% CI, 1.31-5.28]; <0.01), but not in patients admitted in the 3 to 6 hours window (n=193, odds ratio, 1.37 [95% CI, 0.72-2.60]; =0.2). Conclusions- DTAS seems a feasible and safe strategy to improve functional outcome in patients who undergo endovascular treatment mainly within 3 hours from symptoms onset.
背景与目的-直接转至血管造影室（DTAS）方案是一种有前途的措施，可以缩短接受血管内治疗的患者从发病到再通的时间。良好功能结局率随时间的改善幅度取决于几个因素。我们旨在根据发病时间来分析 DTAS 的益处。
方法-回顾性病例对照研究，纳入 174 例连续的 DTAS 病例，匹配 175 例从 2016 年 2 月至 2019 年 6 月直接转至计算机断层扫描（直接转至 CT）的患者。为了在入院时获得可比的组，病例和对照组通过闭塞位置、年龄（±2 岁）、基线国立卫生研究院卒中量表评分（±2 分）和症状出现到入院的时间（±30 分钟）进行匹配。我们分析了 3 个月时的良好功能结局率（改良 Rankin 量表评分，0-2）和按发病后 3 小时内或超过 3 小时分层的安全性变量。
结果-年龄、性别或基线国立卫生研究院卒中量表评分在两组之间无显著差异。DTAS 患者的门到股动脉时间更短（16 [3-21] 分钟与 70 [41.5-98.5]；<0.01）。DTAS 患者在 24 小时时的国立卫生研究院卒中量表评分较低（9 [3.5-17] 与 14 [5-19]；=0.01），症状性出血转化的发生率较低（4.6%与 10.9%，<0.03）。90 天时，DTAS 患者的良好功能结局率更高（43%与 29%；优势比，1.81 [95%可信区间，1.14-2.87]；=0.01）。在发病后 0 至 3 小时内就诊的 DTAS 患者（n=156），结局更好（优势比 2.63 [95%可信区间，1.31-5.28]；<0.01），而在发病后 3 至 6 小时内就诊的患者（n=193），结局没有改善（优势比，1.37 [95%可信区间，0.72-2.60]；=0.2）。
结论-DTAS 似乎是一种可行且安全的策略，可以提高主要在发病后 3 小时内接受血管内治疗的患者的功能结局。
