Inter-hospital transfer for mechanical thrombectomy within the supraregional stroke network NEVAS.

Autor: Feil K; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.; German Center for Vertigo and Balance Disorders, Ludwig Maximilian University (LMU), Munich, Germany., Rémi J; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany., Küpper C; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany., Herzberg M; Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany., Dorn F; Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany., Kunz WG; Department of Radiology, Ludwig Maximilian University (LMU), Munich, Germany., Reidler P; Department of Radiology, Ludwig Maximilian University (LMU), Munich, Germany., Levin J; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany., Hüttemann K; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany., Tiedt S; Institute for Stroke and Dementia Research, Ludwig Maximilian University (LMU), Munich, Germany., Heidger W; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany., Müller K; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany., Thunstedt DC; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany., Dabitz R; Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany., Müller R; Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany., Pfefferkorn T; Department of Neurology, Klinikum Ingolstadt, Ingolstadt, Germany., Hamann GF; Department of Neurology and Neurological Rehabilitation, Bezirkskrankenhaus Günzburg, Günzburg, Germany., Liebig T; Institute of Neuroradiology, Ludwig Maximilian University (LMU), Munich, Germany., Dieterich M; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.; German Center for Vertigo and Balance Disorders, Ludwig Maximilian University (LMU), Munich, Germany.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany., Kellert L; Department of Neurology, Ludwig Maximilians University (LMU), Marchioninistrasse 15, 81377, Munich, Germany. lars.kellert@med.uni-muenchen.de.
Jazyk: angličtina
Zdroj: Journal of neurology [J Neurol] 2021 Feb; Vol. 268 (2), pp. 623-631. Date of Electronic Publication: 2020 Sep 05.
DOI: 10.1007/s00415-020-10165-2
Abstrakt: Background: Telemedicine stroke networks are mandatory to provide inter-hospital transfer for mechanical thrombectomy (MT). However, studies on patient selection in daily practice are sparse.
Methods: Here, we analyzed consecutive patients from 01/2014 to 12/2018 within the supraregional stroke network "Neurovascular Network of Southwest Bavaria" (NEVAS) in terms of diagnoses after consultation, inter-hospital transfer and predictors for performing MT. Degree of disability was rated by the modified Rankin Scale (mRS), good outcome was defined as mRS ≤ 2. Successful reperfusion was assumed when the modified thrombolysis in cerebral infarction (mTICI) was 2b-3.
Results: Of 5722 telemedicine consultations, in 14.1% inter-hospital transfer was performed, mostly because of large vessel occlusion (LVO) stroke. A total of n = 350 patients with LVO were shipped via NEVAS to our center for MT. While n = 52 recanalized spontaneously, MT-treatment was performed in n = 178 patients. MT-treated patients had more severe strokes according to the median National institute of health stroke scale (NIHSS) (16 vs. 13, p < 0.001), were more often treated with intravenous thrombolysis (64.5% vs. 51.7%, p = 0.026) and arrived significantly earlier in our center (184.5 versus 228.0 min, p < 0.001). Good outcome (27.5% vs. 30.8%, p = 0.35) and mortality (32.6% versus 23.5%, p = 0.79) were comparable in MT-treated versus no-MT-treated patients. In patients with middle cerebral artery occlusion in the M1 segment or carotid artery occlusion good outcome was twice as often in the MT-group (21.8% vs. 12.8%, p = 0.184). Independent predictors for performing MT were higher NIHSS (OR 1.096), higher ASPECTS (OR 1.28), and earlier time window (OR 0.99).
Conclusion: Within a telemedicine network stroke care can successfully be organized as only a minority of patients has to be transferred. Our data provide clinical evidence that all MT-eligible patients should be shipped with the fastest transportation modality as possible.
Databáze: MEDLINE
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