Bonifacio-Delgadillo Dulce María, Castellanos-Pedroza Enrique, Martínez-Guerra Bernardo Alfonso, Sánchez-Martínez Claudia Marisol, Marquez-Romero Juan Manuel
Department of Interventional Neurology, Centro Médico Nacional 20 de Noviembre Instituto de Seguridad y Servicios Sociales de Los Trabajadores del Estado (ISSSTE), Mexico City, Mexico.
Departament of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Front Neurol. 2023 Feb 22;14:1103066. doi: 10.3389/fneur.2023.1103066. eCollection 2023.
Founded in 2019, the "ResISSSTE Cerebro" program is the first and only stroke network within the Mexican public health system. One advanced stroke center (ASC) and seven essential stroke centers (ESC) provide acute stroke (AS) care through a modified hub-and-spoke model. This study describes the workflow, metrics, and outcomes in AS obtained during the program's third year of operation.
Participants were adult beneficiaries of the ISSSTE health system in Mexico City with acute focal neurological deficit within 24 h of symptom onset. Initial evaluation could occur at any facility, but the stroke team at the ASC took all decisions regarding treatment and transfers of patients. Registered variables included demographics, stroke risk factors, AS treatment workflow time points, and clinical outcome measures.
We analyzed data from 236 patients, 104 (44.3%) men with a median age of 71 years. Sixty percent of the patients were initially evaluated at the ESC, and 122 (85.9%) were transferred to the ASC. The median transfer time was 123 min. The most common risk factor was hypertension (73.6%). Stroke subtypes were ischemic (86.0%) and hemorrhagic (14.0%). Median times for onset-to-door, door-to-imaging, door-to-needle, and door-to-groin were: 135.5, 37.0, 76.0, and 151.5 min, respectively. The rate of intravenous thrombolysis was 35%. Large vessel occlusion was present in 63 patients, from whom 44% received endovascular therapy; 71.4% achieved early clinical improvement (median NIHSS reduction of 11 points). Treatment-associated morbimortality was 3.4%.
With the implementation of a modified hub-and-spoke model, this study shows that delivery of AS care in low- and middle-income countries is feasible and achieves good clinical outcomes.
“ResISSSTE Cerebro”项目成立于2019年，是墨西哥公共卫生系统内首个也是唯一的卒中网络。一个高级卒中中心（ASC）和七个基本卒中中心（ESC）通过改良的中心辐射模式提供急性卒中（AS）护理。本研究描述了该项目运营第三年期间AS的工作流程、指标和结果。
参与者为墨西哥城ISSSTE卫生系统的成年受益人，症状发作后24小时内出现急性局灶性神经功能缺损。初始评估可在任何机构进行，但ASC的卒中团队负责患者治疗和转运的所有决策。记录的变量包括人口统计学、卒中危险因素、AS治疗工作流程时间点和临床结局指标。
我们分析了236例患者的数据，其中104例（44.3%）为男性，中位年龄71岁。60%的患者最初在ESC接受评估，122例（85.9%）被转运至ASC。中位转运时间为123分钟。最常见的危险因素是高血压（73.6%）。卒中亚型为缺血性（86.0%）和出血性（14.0%）。从症状发作到入院、入院到影像学检查、入院到穿刺、入院到股动脉穿刺的中位时间分别为：135.5、37.0、76.0和151.5分钟。静脉溶栓率为35%。63例患者存在大血管闭塞，其中44%接受了血管内治疗；71.4%实现了早期临床改善（美国国立卫生研究院卒中量表中位降低11分）。治疗相关的病死亡率为3.4%。
通过实施改良的中心辐射模式，本研究表明在低收入和中等收入国家提供AS护理是可行的，并能取得良好的临床效果。
