Rao Rahul R, Desai Shashvat M, Tonetti Daniel A, Manners Jody, Gross Bradley A, Jankowitz Brian, Jovin Tudor G, Jadhav Ashutosh P
The Departments of Neurology, United States.
The Departments of Neurology, United States; Neurological SurgeryUniversity of Pittsburgh Medical Center, Pittsburgh, PA, United States.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105049. doi: 10.1016/j.jstrokecerebrovasdis.2020.105049. Epub 2020 Jun 23.
Patients with large-vessel occlusion (LVO) who initially present to a non-thrombectomy-capable center ("spoke") have worse outcomes than those presenting directly to a thrombectomy-capable center ("hub"). Furthermore, patients who suffer in-hospital strokes (IHS) suffer worse outcomes than those suffering strokes in the community. Data on patients who suffer IHS at a spoke hospital is lacking. We aim to characterize this particularly vulnerable population, define their outcomes, and compare them to patients who develop IHS at a hub institution.
We retrospectively reviewed prospectively collected data from patients suffering an IHS at a spoke hospital who were then transferred to the hub hospital for endovascular therapy (EVT). We then compared outcomes of these patients under EVT after developing IHS at the hub institution.
A total of 108 IHS patients met inclusion criteria: 91 (84%) at a spoke facility and 17 (16%) at the hub facility. Baseline characteristics and reason for hospital admission were comparable between the two groups. Time from imaging to IV-tPA administration (17 vs. 70 min, p = 0.01) and time to EVT (120 vs. 247 min, p = 0.001) were significantly shorter in the hub group. More patients had a 90 day-mRS of 0-3 in the hub group than the spoke group (57% vs 22%, p < 0.05).
Patients undergoing EVT after suffering IHS at a spoke hospital have significantly higher rates of poor outcomes compared to patients who suffer IHS at a hub hospital. Prolonged time delays in the initiation of IV-tPA and EVT represent areas of improvement.
最初就诊于无血栓切除术能力的中心（“辐条”中心）的大血管闭塞（LVO）患者，其预后比直接就诊于有血栓切除术能力的中心（“枢纽”中心）的患者更差。此外，在医院发生卒中（IHS）的患者比在社区发生卒中的患者预后更差。目前缺乏关于在“辐条”医院发生IHS的患者的数据。我们旨在描述这一特别脆弱的人群，确定其预后，并将他们与在“枢纽”机构发生IHS的患者进行比较。
我们回顾性分析了前瞻性收集的数据，这些数据来自在“辐条”医院发生IHS后被转至“枢纽”医院进行血管内治疗（EVT）的患者。然后我们比较了这些患者在“枢纽”机构发生IHS后接受EVT的预后。
共有108例IHS患者符合纳入标准：91例（84%）在“辐条”机构，17例（16%）在“枢纽”机构。两组患者的基线特征和入院原因具有可比性。“枢纽”组从影像学检查到静脉注射组织型纤溶酶原激活剂（IV-tPA）的时间（17分钟对70分钟，p = 0.01）和到EVT的时间（120分钟对247分钟，p = 0.001）明显更短。“枢纽”组90天改良Rankin量表（mRS）评分为0-3的患者比“辐条”组更多（57%对22%，p < 0.05）。
与在“枢纽”医院发生IHS的患者相比，在“辐条”医院发生IHS后接受EVT的患者预后不良率明显更高。IV-tPA和EVT启动的时间延迟较长是需要改进之处。
