Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
German Center for Vertigo and Balance Disorders, Ludwig Maximilian University (LMU), Munich, Germany.
J Neurol. 2021 Feb;268(2):623-631. doi: 10.1007/s00415-020-10165-2. Epub 2020 Sep 5.
Telemedicine stroke networks are mandatory to provide inter-hospital transfer for mechanical thrombectomy (MT). However, studies on patient selection in daily practice are sparse.
Here, we analyzed consecutive patients from 01/2014 to 12/2018 within the supraregional stroke network "Neurovascular Network of Southwest Bavaria" (NEVAS) in terms of diagnoses after consultation, inter-hospital transfer and predictors for performing MT. Degree of disability was rated by the modified Rankin Scale (mRS), good outcome was defined as mRS ≤ 2. Successful reperfusion was assumed when the modified thrombolysis in cerebral infarction (mTICI) was 2b-3.
Of 5722 telemedicine consultations, in 14.1% inter-hospital transfer was performed, mostly because of large vessel occlusion (LVO) stroke. A total of n = 350 patients with LVO were shipped via NEVAS to our center for MT. While n = 52 recanalized spontaneously, MT-treatment was performed in n = 178 patients. MT-treated patients had more severe strokes according to the median National institute of health stroke scale (NIHSS) (16 vs. 13, p < 0.001), were more often treated with intravenous thrombolysis (64.5% vs. 51.7%, p = 0.026) and arrived significantly earlier in our center (184.5 versus 228.0 min, p < 0.001). Good outcome (27.5% vs. 30.8%, p = 0.35) and mortality (32.6% versus 23.5%, p = 0.79) were comparable in MT-treated versus no-MT-treated patients. In patients with middle cerebral artery occlusion in the M1 segment or carotid artery occlusion good outcome was twice as often in the MT-group (21.8% vs. 12.8%, p = 0.184). Independent predictors for performing MT were higher NIHSS (OR 1.096), higher ASPECTS (OR 1.28), and earlier time window (OR 0.99).
Within a telemedicine network stroke care can successfully be organized as only a minority of patients has to be transferred. Our data provide clinical evidence that all MT-eligible patients should be shipped with the fastest transportation modality as possible.
远程医疗卒中网络是提供机械取栓（MT）院内转院的强制性要求。然而，目前针对日常实践中的患者选择的研究还很有限。
本研究分析了 2014 年 1 月至 2018 年 12 月期间，在超区域卒中网络“巴伐利亚西南神经血管网络”（NEVAS）中接受咨询、院内转院和 MT 预测因素的连续患者。残疾程度采用改良 Rankin 量表（mRS）进行评估，预后良好定义为 mRS≤2。当改良脑梗死溶栓（mTICI）达到 2b-3 时，假设再通成功。
在 5722 次远程医疗咨询中，14.1%的患者进行了院内转院，主要是因为大血管闭塞（LVO）卒中。共有 n=350 例 LVO 患者通过 NEVAS 转运至我院进行 MT。其中 n=52 例自发再通，n=178 例患者接受 MT 治疗。与 MT 治疗患者相比，接受 MT 治疗的患者的卒中更为严重，中位数 NIHSS 评分更高（16 分 vs. 13 分，p<0.001），静脉溶栓治疗更为常见（64.5% vs. 51.7%，p=0.026），且更早到达我院（184.5 分钟 vs. 228.0 分钟，p<0.001）。MT 治疗组和未 MT 治疗组的预后良好（27.5% vs. 30.8%，p=0.35）和死亡率（32.6% vs. 23.5%，p=0.79）相当。大脑中动脉 M1 段闭塞或颈内动脉闭塞患者中，MT 组的预后良好率是对照组的两倍（21.8% vs. 12.8%，p=0.184）。行 MT 的独立预测因素包括更高的 NIHSS（OR 1.096）、更高的 ASPECTS（OR 1.28）和更早的时间窗（OR 0.99）。
在远程医疗网络中，可以成功组织卒中治疗，只有少数患者需要转院。我们的数据提供了临床证据，表明所有符合 MT 条件的患者都应尽快通过最快的运输方式转运。
