转诊中心的血管成像在滴注和运输模式中的作用。

The Role of Vascular Imaging atReferral Centers in the Drip and Ship Paradigm.

机构信息

Stroke Unit, Neurology Department, Hospital Universitari Joan XXIII, Tarragona, Spain.

出版信息

J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106209. doi: 10.1016/j.jstrokecerebrovasdis.2021.106209. Epub 2021 Nov 15.

DOI:10.1016/j.jstrokecerebrovasdis.2021.106209

PMID:34794029

Abstract

BACKGROUND

In drip-and-ship protocols, non-invasive vascular imaging (NIVI) at Referral Centers (RC), although recommended, is not consistently performed and its value is uncertain. We evaluated the role of NIVI at RC, comparing patients with (VI+) and without (VI-) vascular imaging in several outcomes.

METHODS

Observational, multicenter study from a prospective government-mandated population-based registry of code stroke patients. We selected acute ischemic stroke patients, initially assessed at RC from January-2016 to June-2020. We compared and analyzed the rates of patients transferred to a Comprehensive Stroke Center (CSC) for Endovascular Treatment (EVT), rates of EVT and workflow times between VI+ and VI- patients.

RESULTS

From 5128 ischemic code stroke patients admitted at RC; 3067 (59.8%) were VI+, 1822 (35.5%) were secondarily transferred to a CSC and 600 (11.7%) received EVT. Among all patients with severe stroke (NIHSS ≥16) at RC, a multivariate analysis showed that lower age, thrombolytic treatment, and VI+ (OR:1.479, CI95%: 1.117-1.960, p=0.006) were independent factors associated to EVT. The rate of secondary transfer to a CSC was lower in VI+ group (24.6% vs. 51.6%, p<0.001). Among transferred patients, EVT was more frequent in VI+ than VI- (48.6% vs. 21.7%, p<0.001). Interval times as door-in door-out (median-minutes 83.5 vs. 82, p= 0.13) and RC-Door to puncture (median-minutes 189 vs. 178, p= 0.47) did not show differences between both groups.

CONCLUSION

In the present study, NIVI at RC improves selection for EVT, and is associated with receiving EVT in severe stroke patients. Time-metrics related to drip-and-ship model were not affected by NIVI.

摘要

背景

在滴注-转运协议中，虽然推荐在转诊中心（RC）进行非侵入性血管成像（NIVI），但并非始终进行，其价值也不确定。我们评估了 RC 中 NIVI 的作用，比较了有（VI+）和无（VI-）血管成像的患者在多个结局中的差异。

方法

这是一项观察性、多中心研究，来自于一项针对急性缺血性脑卒中患者的政府强制、前瞻性、基于人群的登记注册研究。我们选择了 2016 年 1 月至 2020 年 6 月期间在 RC 首次评估的急性缺血性脑卒中患者。我们比较并分析了 VI+和 VI-患者中转至综合性脑卒中中心（CSC）进行血管内治疗（EVT）的比例、EVT 比例以及工作流程时间。

结果

在 5128 例缺血性 CODE 脑卒中患者中，3067 例（59.8%）行 NIVI，1822 例（35.5%）二次转至 CSC，600 例（11.7%）行 EVT。在 RC 有严重脑卒中（NIHSS≥16）的所有患者中，多变量分析显示，年龄较小、溶栓治疗和 NIVI（比值比：1.479，95%置信区间：1.117-1.960，p=0.006）是与 EVT 相关的独立因素。VI+组患者转至 CSC 的比例较低（24.6% vs. 51.6%，p<0.001）。在转至 CSC 的患者中，VI+组行 EVT 的比例高于 VI-组（48.6% vs. 21.7%，p<0.001）。门到门（中位数-分钟 83.5 与 82，p=0.13）和 RC-门到穿刺（中位数-分钟 189 与 178，p=0.47）的时间间隔在两组之间无差异。