Søvik Olav, Øygarden Halvor, Tveiten Arnstein, Kurz Martin Wilhelm, Kurz Kathinka Dæhli, Stokkeland Pål Johan, Hetland Hanne Brit, Ersdal Hege Langli, Hyldmo Per Kristian
Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Department of Research, Sørlandet Hospital, Kristiansand, Norway.
Interv Neuroradiol. 2024 Sep 5:15910199241278036. doi: 10.1177/15910199241278036.
Endovascular thrombectomy, the preferred treatment for acute large-vessel occlusion stroke, is highly time-dependent. Many patients live far from thrombectomy centers due to large geographical variations in stroke services. This study aimed to explore the consequences of long transport distance on the proportion of thrombectomy-eligible patients who underwent thrombectomy, the clinical outcomes with or without thrombectomy, the timelines for patients transported, and the diagnostic accuracy of large-vessel occlusion in primary stroke centers.
We conducted a retrospective observational study in a county with only primary stroke centers, ∼ 300 km from the nearest thrombectomy center. All stroke patients admitted over a year were retrieved from the Norwegian Stroke Registry. A neuroradiologist identified all computed tomography images with large-vessel occlusions. A panel determined whether these patients had a corresponding clinical indication for thrombectomy.
A total of 50% of the eligible patients did not receive thrombectomy. These patients had a significantly higher risk of severe disability or death compared to the patients who underwent thrombectomy. The median time from computed tomography imaging at the primary stroke center to arrival at the thrombectomy center was over 3 hours. Additionally, 30% of the large-vessel occlusions were initially undiagnosed, and half of these patients had a corresponding clinical indication for thrombectomy.
In a county with a long transport distance to a thrombectomy center, a high proportion of eligible patients did not undergo thrombectomy, negatively impacting clinical outcomes. The transport time was considerable. A high rate of large-vessel occlusions was initially not diagnosed.
血管内血栓切除术是急性大血管闭塞性卒中的首选治疗方法，具有高度的时间依赖性。由于卒中服务在地理上存在很大差异，许多患者居住在距离血栓切除中心较远的地方。本研究旨在探讨长途转运对接受血栓切除术的符合血栓切除条件患者比例、接受或未接受血栓切除术的临床结局、患者转运时间线以及初级卒中中心大血管闭塞诊断准确性的影响。
我们在一个仅有初级卒中中心、距离最近的血栓切除中心约300公里的县进行了一项回顾性观察研究。从挪威卒中登记处检索了一年内收治的所有卒中患者。一名神经放射科医生识别出所有存在大血管闭塞的计算机断层扫描图像。一个专家小组确定这些患者是否有相应的血栓切除临床指征。
共有50%的符合条件患者未接受血栓切除术。与接受血栓切除术的患者相比，这些患者出现严重残疾或死亡的风险显著更高。从初级卒中中心进行计算机断层扫描成像到抵达血栓切除中心的中位时间超过3小时。此外，30%的大血管闭塞最初未被诊断出来，其中一半患者有相应的血栓切除临床指征。
在一个距离血栓切除中心转运距离较长的县，很大比例的符合条件患者未接受血栓切除术，对临床结局产生了负面影响。转运时间相当长。大血管闭塞最初未被诊断出的比例很高。
