Rinsho Shinkeigaku (Clinical Neurology)

Original Article

To optimize the initial assessment for stroke patients transferred from general hospital may improve the clinical outcome after endovascular thrombectomy

Junya Aoki, M.D.1), Kentaro Suzuki, M.D.1), Takuya Kanamaru, M.D.1), Yohei Takayama, M.D.1), Takehiro Katano, M.D.1), Akihito Kutsuna, M.D.1), Satoshi Suda, M.D.1), Yasuhiro Nishiyama, M.D.1), Seiji Okubo, M.D.1) and Kazumi Kimura, M.D.1)

1)Department of Neurological Science, Nippon Medical School Graduate School of Medicine

Rapid adaption of endovascular thrombectomy (EVT) is essential for patients with large arterial occlusion (LAO). Although patients transferred need longer transportation, they have an advantage of preadmission diagnosis regarding arterial occlusion. The aim of the present study is to evaluate whether optimizing the assessment at comprehensive center for patients transferred may improve the clinical outcome after EVT. Data on consecutive patients treated with EVT between September 2014 and May 2017 were studied. Generally, we have two distinct protocols for EVT candidates: 1) the transfer group, patients are directly taken to the CT and escorted to the angiography room; and 2) the direct group, patients receive the routine emergent evaluation and examined with MRI/MRA. Good outcome was defined as modified Rankin Scale score ≤1 at 3 months. Thirty-one (29%) patients were classified into the transfer group and the 77 (71%) were into the direct group. Although the onset to door time was longer in the transfer group (175 [137-275] min. vs. 76 [51-260] min, P = 0.001), the rate of good outcome was similar between the 2 groups (41% vs. 25%, P = 0.205). By multivariate regression analysis, the onset to reperfusion time was the independent factor (odds ratio 0.982, 95%CI: 0.967-0.998, P = 0.026) associated with good outcome, while transfer itself was not the independent parameter (odds ratio 0.732, 95%CI: 0.125-4.291, P = 0.730). Regarding time parameters, door to picture time (11 [7-24] min vs. 27 [21-39] min., P < 0.001) and picture to puncture time (27 [18-60] min. vs. 54 [39-78] min, P < 0.001) were shorter in the transfer group. Thus, the onset to puncture time (234 [177-299] min. vs. 170 [125-367] min, P = 0.063) and the onset to reperfusion time (271 [208-352] min. vs. 237 [159-382] min., P = 0.183) were similar between the 2 groups. Shortening the initial evaluation at comprehensive stroke center can provide a good outcome for patients transferred.
Full Text of this Article in Japanese PDF (454K)

(CLINICA NEUROL, 58: 471|478, 2018)
key words: endovascular thrombectomy, hospital transportation, onset to reperfusion time

(Received: 22-Apr-18)