Kikuchi Bumpei, Ando Kazuhiro, Mouri Yoshihiro, Takino Toru, Watanabe Jun, Tamura Tetsuro, Yamashita Shinya
Department of Neurosurgery, Niigata Prefectural Central Hospital, Joetsu, Niigata, Japan.
J Neuroendovasc Ther. 2022;16(11):547-555. doi: 10.5797/jnet.oa.2022-0047. Epub 2022 Oct 15.
Time to recanalization is directly linked to cerebral infarction prognosis. However, patients transferred from another hospital take longer to arrive than those transported directly. To minimize time to recanalization, the emergency room (ER) skip strategy for hospital transfers was executed and reviewed.
From April 2019, patients transferred from another hospital for mechanical thrombectomy were carried into the angio-suite using emergency service stretchers. Results for these patients (ER skip group) were compared with those for patients transported directly to our hospital (Direct group).
Among 108 cases in 32 months, 99 patients (91.7%) had major cerebral artery occlusion and underwent endovascular treatment. No differences in age, baseline National Institutes of Health Stroke Scale score, effective recanalization rate, or proportion of posterior circulation cases were seen between groups. The ER skip group (26 patients) showed significantly longer median time from onset to arrival (240 vs. 120 min; p = 0.0001) and significantly shorter median time from arrival to groin puncture (11 vs. 69 min; p = 0.0000). No significant differences were evident in time from groin puncture to recanalization (39 vs. 45 min), time from onset to recanalization (298 vs. 244 min), or rate of modified Rankin Scale score 0-2 after 90 days (42.3% vs. 32.9%). Median time from alarm to recanalization (266 vs. 176 min; p = 0.0001) was significantly longer in the ER skip group. Door-to-puncture (DTP) time for the Direct group gradually fell as the number of cases increased, reaching 40 min by the end of study period. In contrast, DTP time for the ER skip group remained extremely short and did not change further. The proportion of patients who underwent both CT and MRI before endovascular treatment was significantly lower in the Direct group (30.1%) than in the ER skip group (57.7%). In the ER skip group, median length of stay in the primary hospital was 119 min, and the median duration of interhospital transfer was 16 min.
The ER skip strategy for patients transferred with large vessel occlusion achieved favorable outcomes comparable to that for direct transport cases. Direct transport to a thrombectomy-capable stroke center remains ideal, however, because the time to intervention is improving for direct transport cases each year.
再通时间与脑梗死预后直接相关。然而，从其他医院转来的患者比直接送来的患者到达时间更长。为了尽量缩短再通时间，实施并评估了针对医院转运的急诊室（ER）跳过策略。
从2019年4月起，将从其他医院转来进行机械取栓的患者用急救担架抬入血管造影室。将这些患者的结果（ER跳过组）与直接转运至我院的患者（直接组）的结果进行比较。
在32个月内的108例病例中，99例患者（91.7%）存在大脑主要动脉闭塞并接受了血管内治疗。两组在年龄、基线美国国立卫生研究院卒中量表评分、有效再通率或后循环病例比例方面均无差异。ER跳过组（26例患者）从发病到到达的中位时间显著更长（240分钟对120分钟；p = 0.0001），从到达至腹股沟穿刺的中位时间显著更短（11分钟对69分钟；p = 0.0000）。从腹股沟穿刺到再通的时间（39分钟对45分钟）、从发病到再通的时间（298分钟对244分钟）或90天后改良Rankin量表评分为0 - 2的比例（42.3%对32.9%）均无显著差异。ER跳过组从警报至再通的中位时间（266分钟对176分钟；p = 0.0001）显著更长。直接组的门到穿刺（DTP）时间随着病例数增加而逐渐下降，在研究期结束时达到40分钟。相比之下，ER跳过组的DTP时间一直极短且未进一步变化。直接组在血管内治疗前同时进行CT和MRI检查的患者比例（30.1%）显著低于ER跳过组（57.7%）。在ER跳过组中，在原医院的中位住院时间为119分钟，院间转运的中位持续时间为16分钟。
对于因大血管闭塞而转院的患者，ER跳过策略取得了与直接转运病例相当的良好结果。然而，直接转运至有取栓能力的卒中中心仍然是理想的选择，因为直接转运病例的干预时间每年都在缩短。
