Department of Neurosurgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan.
Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
PLoS One. 2021 Jan 19;16(1):e0245082. doi: 10.1371/journal.pone.0245082. eCollection 2021.
Mechanical thrombectomy (MT) is standard treatment for acute ischemic stroke (AIS) with large-vessel occlusion within 6 h of symptom onset to treatment initiation (OTP). Recent trials have extended the therapeutic time window for MT to within 24 h. However, MT treatment remains low in remote areas. Nagasaki Prefecture, Japan has many inhabited islands with no neurointerventionalists. Our hospital on the mainland is a regional hub for eight island hospitals. We evaluated clinical outcomes of MT for patients with AIS on these islands versus on the mainland.
During 2014-2019, we reviewed consecutive patients with AIS who received MT at our hospital. Patients comprised the Islands group and Mainland group. Patient characteristics and clinical outcomes were compared between groups.
We included 91 patients (Islands group: 15 patients, Mainland group: 76 patients). Seven patients (46.7%) in the Islands group versus 43 (56.6%) in the Mainland group achieved favorable outcomes. Successful recanalization was obtained in 11 patients (73.3%) on the islands and 67 (88.2%) on the mainland. The median OTP time in the Islands was 365 min. In both the Islands and Mainland groups, the OTP time and successful recanalization were associated with functional outcome. The modified Rankin Scale (mRS) score at 90 days ≤2 was obtained in two patients and mRS = 3 in four patients among eight patients with OTP time >6 h.
Few patients with AIS on remote islands have received MT. Although patients who underwent MT on the islands had longer OTP, the clinical outcomes were acceptable. OTP time on remote islands must be shortened, as this is related to functional outcome. In some cases with successful recanalization, a favorable outcome can still be obtained even after 6 h. Even if OTP exceeds 6 h, it is desirable to appropriately select patients and actively perform MT.
机械取栓（MT）是发病 6 小时内至治疗开始时间（OTP）的急性缺血性脑卒中（AIS）大血管闭塞患者的标准治疗方法。最近的试验将 MT 的治疗时间窗延长至 24 小时内。然而，偏远地区的 MT 治疗仍然较少。日本长崎县有许多有人居住的岛屿，没有神经介入医生。我们位于大陆的医院是八所岛屿医院的区域中心。我们评估了这些岛屿上和大陆上 AIS 患者接受 MT 的临床结局。
在 2014 年至 2019 年期间，我们回顾了在我院接受 MT 的连续 AIS 患者。患者分为岛屿组和大陆组。比较两组患者的一般资料和临床结局。
共纳入 91 例患者（岛屿组：15 例，大陆组：76 例）。岛屿组 7 例（46.7%）患者和大陆组 43 例（56.6%）患者获得良好结局。11 例（73.3%）患者在岛上实现再通，67 例（88.2%）患者在大陆上实现再通。岛屿组的中位 OTP 时间为 365 分钟。在岛屿组和大陆组中，OTP 时间和再通成功与功能结局相关。8 例 OTP 时间＞6 小时的患者中，有 2 例患者 90 天 mRS 评分≤2，4 例患者 mRS=3。
偏远岛屿上的 AIS 患者接受 MT 的人数较少。尽管在岛上接受 MT 的患者 OTP 时间较长，但临床结局尚可。必须缩短偏远岛屿的 OTP 时间，因为这与功能结局相关。在一些再通成功的情况下，即使超过 6 小时，仍可获得良好结局。即使 OTP 超过 6 小时，也希望适当选择患者并积极进行 MT。
