Imahori Taichiro, Koyama Junji, Tanaka Kazuhiro, Okamura Yusuke, Arai Atsushi, Iwahashi Hirofumi, Mori Tatsuya, Yokote Akiyoshi, Matsushima Kazushi, Matsui Daisaku, Kobayashi Makoto, Hosoda Kohkichi, Kohmura Eiji
Department of Neurosurgery, Toyooka Hospital, Hyogo, Japan.
Department of Neurology, Toyooka Hospital, Hyogo, Japan.
Heliyon. 2020 May 13;6(5):e03945. doi: 10.1016/j.heliyon.2020.e03945. eCollection 2020 May.
Endovascular treatment (EVT) has increasingly become the standard treatment of acute cerebral large vessel occlusion (LVO). We evaluated the impact of introducing EVT on LVO therapy in a single center where intravenous thrombolysis (IVT) had been the only recanalization therapy.
Between April 2013 and March 2017, 354 consecutive patients with LVO admitted to our institution were analyzed. We compared outcomes between two chronological groups before (Pre-EVT group) and after (Post-EVT group) introducing EVT in April 2015. We assessed prognostic factors for favorable outcomes (modified Rankin scale score ≤2 at 90 days).
In the Pre-EVT group, all 140 patients were treated medically, including 30 patients (21%) undergoing IVT. In the Post-EVT group, 118 patients (55%) underwent EVT, and the remaining 96 patients treated medically, including six patients (3%) undergoing IVT. The proportion undergoing recanalization therapy with IVT or EVT significantly increased after introducing EVT (21% versus 58%, p < 0.001). The rate of patients achieving favorable outcomes also significantly increased (14% versus 31%, p < 0.001). In multivariate regression analysis, introducing EVT was an independent predictive factor after adjusting for age, stroke severity and extent, and time (p = 0.005). The arrival time in patients with helicopter transport was significantly shorter than that with ground ambulance for a distance of more than 10 km (p < 0.001).
This study demonstrated that the introduction of EVT improved outcomes of acute LVO patients, increasing the opportunity to receive recanalization therapy. Further efforts to establish medical systems to provide EVT are required throughout the country.
血管内治疗（EVT）日益成为急性脑大动脉闭塞（LVO）的标准治疗方法。我们评估了在一个仅将静脉溶栓（IVT）作为唯一再通治疗方法的单中心引入EVT对LVO治疗的影响。
对2013年4月至2017年3月期间连续收治的354例LVO患者进行分析。我们比较了2015年4月引入EVT之前（EVT前组）和之后（EVT后组）两个按时间顺序分组的患者的结局。我们评估了90天时预后良好（改良Rankin量表评分≤2）的预后因素。
在EVT前组中，所有140例患者均接受药物治疗，其中30例（21%）接受了IVT。在EVT后组中，118例患者（55%）接受了EVT，其余96例患者接受药物治疗，其中6例（3%）接受了IVT。引入EVT后，接受IVT或EVT再通治疗的比例显著增加（21%对58%，p<0.001）。达到良好结局的患者比例也显著增加（14%对31%，p<0.001）。在多因素回归分析中，调整年龄、卒中严重程度和范围以及时间后，引入EVT是一个独立的预测因素（p=0.005）。对于距离超过10公里的患者，直升机转运患者的到达时间明显短于地面救护车转运患者（p<0.001）。
本研究表明，引入EVT改善了急性LVO患者的结局，增加了接受再通治疗的机会。全国需要进一步努力建立提供EVT的医疗系统。
