Transport strategy for ischaemic stroke patients with large vessel occlusion.

Autor:	Černík D; Comprehensive Stroke Center, Department of Neurology, Masaryk Hospital Ústí nad Labem, KZ a.s., Ústí nad Labem, Czech Republic. david.cernik@seznam.cz., Cihlář F; Department of Radiology, Masaryk Hospital, KZ a.s., Faculty of Health Studies, J.E. Purkinje University, Ústí nad Labem, Czech Republic., Neumann J; Department of Neurology, Hospital Chomutov, KZ a.s., Chomutov, Czech Republic., Doláková Ľ; 2nd Children clinic Slovak Medical University Children's faculty hospital Banská Bystrica, Slovakia., Šaňák D; Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic., Cihlář D; Department of Physical Education and Sport, Pedagogical faculty Jan Evangelista Purkyně University in Ústí nad Labem, Czech Republic., Orlický M; Department of Neurosurgery, Faculty of Medicine, University of L.Pasteur, Košice, Slovakia.; Department of Neurosurgery, Masaryk Hospital, KZ a.s., Faculty of Health Studies, J.E. Purkinje University, Ústí nad Labem, Czech Republic.
Jazyk:	angličtina
Zdroj:	Neurologia i neurochirurgia polska [Neurol Neurochir Pol] 2022; Vol. 56 (6), pp. 464-471. Date of Electronic Publication: 2022 Jul 28.
DOI:	10.5603/PJNNS.a2022.0054
Abstrakt:	Introduction: There are today two models of transporting patients with acute ischaemic stroke because of large artery occlusion (AIS-LVO): mothership (MS) and drip-and-ship (DS). Our aim was to evaluate our ongoing transport strategy (OT), which is an MS/DS hybrid. In our OT, the patient is transported directly to the CT of the Primary Stroke Centre (PSC), where intravenous thrombolysis (IVT) is administered. The patient then continues without delay to a Comprehensive Stroke Centre (CSC) with the same medical rescue team (MRT). The distance between our centres is 73 km. Material and Methods: We retrospectively analysed data of 100 consecutive AIS-LVO patients treated with mechanical thrombectomy (MT) between January 2017 and October 2019. OT, MS and DS groups were compared. 31 patients were transported as MS, 32 as DS, and 37 as OT. Results: DS had significantly longer time to groin puncture (185 min) compared to OT and MS (p < 0.0001). OT shortened time almost to MS level (OT 124 min, MS 110 min, p = 0.002. Time to IVT administration (from MRT departure) differed statistically significantly in favour of OT (OT 27 min, MS 63 min, p < 0.0001). Logistical change in PSC had a significant effect on decreasing the door-to-needle time (DNT) median from 37 min to 11 min (p < 0.0001). DNT reduction also occurred in patients with AIS and without an indication for MT. Conclusions: OT is highly effective, significantly reducing the time to IVT administration, and combining all the benefits, while eliminating all the disadvantages, of DS and MS. The OT concept gives all indicated patients a chance for MT to be performed, and does not overload the performing centre.
Databáze:	MEDLINE
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