Outcome of patients with large vessel occlusion stroke after first admission in telestroke spoke versus comprehensive stroke center.

Autor:	Kaminsky AL; Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France al.kaminsky@chru-nancy.fr., Mione G; Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France., Omorou Y; Centre d'Investigation Clinique-CIC 1433 Epidémiologie Clinique, CHU Nancy, Nancy, Lorraine, France., Humbertjean L; Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France., Bonnerot M; Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France., Lacour JC; Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France., Riou-Comte N; Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France., Anadani M; Washington University School of Medicine in St Louis, St Louis, Missouri, USA.; Neurology, Medical University of South Carolina-College of Medicine, Charleston, South Carolina, USA., Gory B; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy INSERM U1254, Nancy, France., Richard S; Department of Neurology, Stroke Unit, University Hospital of Nancy, Nancy, France.; Centre d'Investigation Clinique plurithématique CIC 1433, CHRU, Nancy, Lorraine, France.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2020 Aug; Vol. 12 (8), pp. 753-757. Date of Electronic Publication: 2019 Dec 09.
DOI:	10.1136/neurintsurg-2019-015342
Abstrakt:	Introduction: While telestroke allows early intravenous thrombolysis (IVT) for ischemic strokes in spoke centers, mechanical thrombectomy (MT) for large vessel occlusion (LVO) is mainly performed at comprehensive stroke centers (CSCs). We aimed to compare 3 month outcome in patients with LVO after admission to a spoke center using telestroke compared with first CSC admission in our large regional stroke network, irrespective of final treatment decision. Methods: All consecutive LVO patients who were admitted to one of six spoke centers or to the regional CSC within 6 hours of symptom onset were prospectively included from September 1, 2015 to August 31, 2017. All patients admitted to spoke centers were assessed on site with cerebral and vessel imaging. Primary outcome was 3 month favorable outcome (modified Rankin Scale score of 0-2). Results: Distances between spoke centers and CSC ranged from 36 to 77 miles. Among 207 included patients, 132 (63.8%) were first admitted to CSCs and 75 (36.2%) to spoke centers. IVT was administered more in spoke centers (81.3% vs 53.8%, p<0.0001) while MT was performed less (26.7% vs 49.2%, p=0.001) and with a longer time from onset (303 vs 200 min, p<0.0001). No difference was found in 3 month favorable outcome between spoke centers compared with CSCs (32.0% and 35.1%, respectively; OR=0.68; 95% CI 0.42 to 1.10; p=0.12). Conclusions: Despite different distribution of reperfusion therapies for LVO patients managed by telemedicine, we could not demonstrate a difference in functional outcome according to admission location in a large area with long distances between centers. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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