Endovascular thrombectomy at low-volume centres: A Bayesian solution.

Autor: Rezai MK; Department of Neurology, Stavanger University Hospital, Stavanger, Norway.; Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway., Advani R; Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway.; Stroke Unit, Department of Neurology, Oslo University Hospital, Oslo, Norway., Sandve KO; Department of Radiology, Stavanger University Hospital, Stavanger, Norway.; SMIL Stavanger Medical Imaging Laboratory, Stavanger University Hospital, Stavanger, Norway., Fjetland L; Department of Radiology, Stavanger University Hospital, Stavanger, Norway.; SMIL Stavanger Medical Imaging Laboratory, Stavanger University Hospital, Stavanger, Norway., Kurz KD; Department of Radiology, Stavanger University Hospital, Stavanger, Norway.; SMIL Stavanger Medical Imaging Laboratory, Stavanger University Hospital, Stavanger, Norway.; Department of Electrical and Computer Engineering, University of Stavanger, Stavanger, Norway., Kurz MW; Department of Neurology, Stavanger University Hospital, Stavanger, Norway.; Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway.; Department of Clinical Science, University of Bergen, Bergen, Norway.
Jazyk: angličtina
Zdroj: Acta neurologica Scandinavica [Acta Neurol Scand] 2020 Aug; Vol. 142 (2), pp. 169-174. Date of Electronic Publication: 2020 May 04.
DOI: 10.1111/ane.13252
Abstrakt: Purpose: Endovascular treatment (EVT) is traditionally performed by neurointerventional radiologists at tertiary medical centres imposing long transport ways to large vessel occlusion (LVO) stroke patients in rural areas. The purpose of this study is to evaluate the technical and clinical results over time at Stavanger University Hospital, a hospital without neurointerventional expertise, where trained general interventional radiologist performs EVT.
Methods: All patients with LVO stroke treated with EVT from May 2009 to December 2018 were included in the analysis. Technical outcome was measured by the modified treatment in cerebral ischaemia (mTICI) score, functional outcome by the modified Rankin Scale (mRS), complications registered.
Results: A total of 235 patients were treated with EVT. An angiographically good result (mTICI 2b or 3) could be seen in 66.7% of the patients treated the first year. In 2011, the year EVT with stent retrievers was introduced, the recanalization rate rose to 81.8%, and from 2014 onwards, it was stable around 80%. After introduction of aspiration together with stent retrievers in 2012, a good functional outcome (mRS 0-2) was obtained in >40% of the treated patients. In 2018, 61.1% of the patients got a good functional outcome.
Conclusions: Endovascular treatment of LVO stroke performed by general vascular interventional radiologist in close collaboration with diagnostic neuroradiologists and stroke neurologists can achieve technical revascularization results and clinical patient outcomes in line with international recommendations, and the randomized controlled studies performed. This approach may help to introduce EVT in geographical areas where this service is lacking due to the absence of neurointerventional specialists.
(© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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