Nishihori Masahiro, Izumi Takashi, Tsukada Tetsuya, Yokoyama Kinya, Uda Kenji, Araki Yoshio, Wakabayashi Toshihiko
Department of Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
J Neuroendovasc Ther. 2021;15(10):629-636. doi: 10.5797/jnet.oa.2020-0097. Epub 2021 Jan 27.
Mechanical thrombectomy in acute ischemic stroke (AIS) has become popular in recent years. Our affiliated institutes without neuro-endovascular specialists call our department to come to assist and perform thrombectomy (Drip and Go). In this study, the effectiveness of this inter-hospital cooperative system was evaluated.
Between January 2016 and December 2018, "Drip and Go" was performed in a total of 29 patients (20 males, average age of 75 years) from four hospitals located within a 1-hour drive, that frequently called for AIS assistance. The background and outcomes of such cases were then retrospectively collected and evaluated.
The median National Institutes of Health Stroke Scale (NIHSS) and diffusion-weighed image-Alberta Stroke Programme Early CT Score (DWI-ASPECTS) were 19 and 7, respectively. Gro in puncture was performed in 27 patients (93%) within 6 h of onset. Good reperfusion (thrombolysis in cerebral infarction [TICI] 2b/3) was obtained in 24 patients (82%) with only one patient exhibiting hemorrhagic complication. A total of 12 patients (41%) had a modified Rankin Scale (mRS) score of 0-3 after 90 days or at the time of discharge. Univariate analysis identified a DWI-ASPECTS of 7 or higher as the only significant factor associated with a good neurological prognosis (P <0.05). Neurological prognosis was the most favorable at the furthest hospital where patients had a good DWI-ASPECTS.
By employing a 1-hour arrival time window and proper patient selection, the "Drip and Go" inter-hospital cooperative system can be an alternative approach for covering areas where no neuro-endovascular specialists are available for AIS.
近年来，急性缺血性卒中（AIS）的机械取栓术已变得流行。我们附属机构中没有神经血管内介入专家的医院会打电话给我们科室前来协助并进行取栓术（静脉溶栓联合血管内治疗）。在本研究中，评估了这种院际合作系统的有效性。
2016年1月至2018年12月期间，对距离我院1小时车程内的四家经常寻求AIS治疗协助的医院中的29例患者（20例男性，平均年龄75岁）实施了“静脉溶栓联合血管内治疗”。然后回顾性收集并评估这些病例的背景和结果。
美国国立卫生研究院卒中量表（NIHSS）中位数和弥散加权成像-阿尔伯塔卒中项目早期CT评分（DWI-ASPECTS）分别为19分和7分。27例患者（93%）在发病6小时内进行了股动脉穿刺。24例患者（82%）实现了良好再灌注（脑梗死溶栓分级[TICI]2b/3级），仅1例患者出现出血并发症。90天后或出院时，共有12例患者（41%）改良Rankin量表（mRS）评分为0 - 3分。单因素分析确定DWI-ASPECTS为7分或更高是与良好神经功能预后相关的唯一显著因素（P<0.05）。在DWI-ASPECTS良好的最远医院，神经功能预后最为理想。
通过采用1小时到达时间窗并进行适当的患者选择，“静脉溶栓联合血管内治疗”院际合作系统可以作为一种替代方法，用于覆盖没有神经血管内介入专家进行AIS治疗的地区。
