Department of Neuroradiology, Hôpital Gui de Chauliac, Montpellier, France.
Department of Neurology, St. Jean Hospital, Perpignan, France.
Eur Stroke J. 2024 Dec;9(4):936-942. doi: 10.1177/23969873241254239. Epub 2024 May 17.
Too few patients benefit from endovascular therapy (EVT) in large vessel occlusion acute stroke (LVOS), and various acute stroke care paradigms are currently investigated to reduce these inequalities in health access. We aimed to investigate whether newly set-up thrombectomy-capable stroke centers (TSC) offered a safe, effective and cost-effective procedure.
This French retrospective study compared the outcomes of LVOS patients with an indication for EVT and treated at the Perpignan hospital before on-site thrombectomy was available (Primary stroke center), and after formation of local radiology team for neurointervention (TSC). Primary endpoints were 3-months functional outcomes, assessed by the modified Rankin scale. Various safety endpoints for ischemic and hemorragic procedural complications were assessed. We conducted a medico-economic analysis to estimate the cost-benefit of becoming a TSC for the hospital.
The differences between 422 patients in the PSC and 266 in the TSC were adjusted by the means of weighted logistic regression. Patients treated in the TSC had higher odds of excellent functional outcome (aOR 1.77 [1.16-2.72], = 0.008), with no significant differences in the rates of procedural complications. The TSC setting shortened onset-to-reperfusion times by 144 min (95% CI [131-155]; < 0.0001), and was cost-effective after 21 treated LVOS patients. On-site thrombectomy saves 10.825€ per patient for the hospital.
Our results demonstrate that the TSC setting improves functional outcomes and reduces intra-hospital costs in LVOS patients. TSCs could play a major public health role in acute stroke care and access to EVT.
在大血管闭塞性急性脑卒中（LVOS）中，接受血管内治疗（EVT）的患者获益甚少，目前正在研究各种急性脑卒中治疗模式，以减少在获得卫生服务方面的这些不平等。我们旨在研究新建立的具备取栓能力的卒中中心（TSC）是否提供了一种安全、有效和具有成本效益的治疗方法。
这项法国回顾性研究比较了在当地神经介入放射学团队成立（TSC）之前在佩皮尼昂医院接受治疗（初级卒中中心）和之后有现场取栓能力的 LVOS 患者的治疗效果。主要终点是 3 个月时的改良 Rankin 量表评估的功能结局。评估了缺血性和出血性程序并发症的各种安全性终点。我们进行了医疗经济分析，以估计成为 TSC 对医院的成本效益。
通过加权逻辑回归调整了初级卒中中心的 422 例患者和 TSC 的 266 例患者之间的差异。在 TSC 中治疗的患者具有更好的功能结局的可能性更高（调整后优势比 1.77[1.16-2.72]， = 0.008），但程序并发症的发生率没有显著差异。TSC 设置将发病到再灌注时间缩短了 144 分钟（95%CI [131-155]； < 0.0001），并且在 21 例接受治疗的 LVOS 患者中具有成本效益。医院每例患者的现场取栓可节省 10.825 欧元。
我们的研究结果表明，TSC 环境可改善 LVOS 患者的功能结局，并降低医院内的成本。TSC 在急性脑卒中护理和获得 EVT 方面可以发挥重要的公共卫生作用。
