University of Alberta, Department of Medicine, Division of Neurology, Edmonton, Canada.
University of Alberta, Department of Radiology and Diagnostic imaging, Edmonton, Canada.
Can J Neurol Sci. 2024 Mar;51(2):226-232. doi: 10.1017/cjn.2023.36. Epub 2023 Mar 29.
Early reperfusion has the best likelihood for a favorable outcome in acute ischemic stroke (AIS) with large vessel occlusion (LVO). Our experience with mobile stroke unit (MSU) for direct to angiosuite (DTAS) transfer in AIS patients with suspected LVO is presented.
Retrospective review of prospectively collected data from November 2019 to August 2022, of patients evaluated and transferred by the University of Alberta Hospital MSU and moved to angiosuite for endovascular thrombectomy (EVT).
A total of 41 cases were included. Nine were chosen for DTAS and 32 were shifted to angiosuite after stopping for computed tomography (CT) angiography of the head and neck (no-DTAS). Stroke severity measured by NIHSS (median with interquartile range (IQR)) was higher in patients of DTAS, 22 (14-24) vs 14.5 (5-25) in no-DTAS ( = 0.001). The non-contrast CT head in MSU showed hyperdense vessels in 8 (88.88%) DTAS vs 11 (34.35%) no-DTAS patients ( = 0.003). The EVT timelines (median with IQR, 90 percentile) including "door to artery puncture time" were 31 (23-50, 49.2) vs 79 (39-264, 112.8) minutes, and "door to recanalization time" was 69 (49-110, 93.2) vs 105.5 (52-178, 159.5) minutes in DTAS vs no-DTAS group, respectively. The workflow times were significantly shorter in the DTAS group ( < 0.001). Eight (88.88%) out of 9 DTAS patients had LVO and underwent thrombectomy.
MSU for DTAS in patients with high NIHSS scores, cortical signs, and CT showing hyperdense vessel is an effective strategy to reduce the EVT workflow time.
急性缺血性脑卒中（AIS）伴大血管闭塞（LVO）患者，早期再灌注有获得良好结局的最佳可能性。我们介绍了使用移动卒中单元（MSU）直接将疑似 LVO 的 AIS 患者转运至血管内治疗室（angiosuite）进行治疗的经验。
回顾性分析 2019 年 11 月至 2022 年 8 月期间，由艾伯塔大学医院 MSU 评估和转运，并进行头颈部 CT 血管造影（CTA）后转运至血管内治疗室进行血管内血栓切除术（EVT）的患者的前瞻性采集数据。
共纳入 41 例患者。9 例患者选择行 DTAS，32 例患者因停止头颈部 CTA 后行血管内治疗（无 DTAS）。DTAS 组患者 NIHSS 评分（中位数，四分位距（IQR））更高，为 22（14-24）分，无 DTAS 组为 14.5（5-25）分（ = 0.001）。MSU 中的非对比 CT 头部显示，8（88.88%）例 DTAS 患者的血管显影高密度，11（34.35%）例无 DTAS 患者的血管显影高密度（ = 0.003）。EVT 时间线（中位数，IQR，90%分位数），包括“门到动脉穿刺时间”，分别为 31（23-50，49.2）和 79（39-264，112.8）分钟，以及“门到再通时间”，分别为 69（49-110，93.2）和 105.5（52-178，159.5）分钟。DTAS 组的工作流程时间明显更短（ < 0.001）。9 例 DTAS 患者中，8 例（88.88%）存在 LVO，并进行了血栓切除术。
对于 NIHSS 评分高、皮质体征、CT 显示高密度血管的患者，使用 MSU 进行 DTAS 是一种有效的策略，可以缩短 EVT 工作流程时间。
