Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA.
Institute for Stroke and Cerebrovascular disease, University of Texas Health Science Center at Houston, Houston, TX, USA.
J Telemed Telecare. 2022 Sep;28(8):595-602. doi: 10.1177/1357633X20957894. Epub 2020 Sep 20.
In a telestroke network, patients at a referring hospital (RH) with large-vessel occlusion (LVO) are transferred to a comprehensive stroke centre (CSC) for endovascular thrombectomy (EVT). However, a significant number of patients do not ultimately undergo thrombectomy after CSC arrival.
Within a 17-hospital telestroke network, we retrospectively analysed patients with suspected or confirmed LVO transferred to a CSC, and characterized the reasons why these patients did not undergo EVT based on the 2019 American Heart Association guidelines.
Of 400 patients transferred to our hub, 68 (17%) were based on vascular imaging at RH. Time from RH arrival to neuroimaging was significantly longer in patients that underwent both computed tomography (CT) and CT angiography of the brain and neck compared to only CT of the brain (53 vs 13 minutes, p < 0.05). Accuracy of anterior circulation LVO (ACLVO) detection based on clinical suspicion was 62% (205 of 332 patients). Among 234 ACLVO patients, overall, 175 (74%) (early window group: 123 (73%) patients and late window group: 52 (80%) patients) met at least one EVT ineligibility criterion. The reasons for EVT ineligibility varied from large core infarct (aspects <6 or core volume >70 cc on perfusion imaging in late window), low National Institutes of Health Stroke Scale (<6), distal occlusion, and poor baseline modified Rankin Scale score (>1).
Instituting rapid acquisition and interpretation of vascular imaging at RHs for LVO detection and establishing benchmarks for door to vascular imaging is urgently needed for RHs.
在远程卒中网络中，转诊医院（RH）的大血管闭塞（LVO）患者会被转至综合卒中中心（CSC）接受血管内血栓切除术（EVT）。然而，仍有相当数量的患者在到达 CSC 后最终未进行血栓切除术。
在一个由 17 家医院组成的远程卒中网络中，我们对被转至 CSC 的疑似或确诊 LVO 患者进行了回顾性分析，并根据 2019 年美国心脏协会指南，对这些患者未接受 EVT 的原因进行了特征描述。
在转至我们中心的 400 名患者中，有 68 名（17%）是基于 RH 的血管影像学检查。与仅行脑部 CT 检查的患者相比，同时行脑部和颈部 CT 血管造影检查的患者从 RH 到达至神经影像学检查的时间明显延长（53 分钟比 13 分钟，p < 0.05）。基于临床怀疑对前循环大血管闭塞（ACLVO）的检测准确率为 62%（332 名患者中的 205 名）。在 234 名 ACLVO 患者中，整体上，175 名（74%）（早期窗口组：123 名（73%）患者和晚期窗口组：52 名（80%）患者）符合至少一项 EVT 禁忌标准。EVT 禁忌的原因包括大核心梗死（在晚期窗口的灌注成像上，核心面积<6 或核心体积>70 cc）、NIHSS 评分较低（<6）、远端闭塞和较差的基线改良 Rankin 量表评分（>1）。
迫切需要在 RH 快速获取和解读 LVO 血管影像学检查，并为 RH 建立门到血管影像学检查的基准。
