Barriers to stroke treatment: The price of long-distance from thrombectomy centers.

Autor:	Søvik O; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.; Department of Research, Sørlandet Hospital, Kristiansand, Norway., Øygarden H; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Neurology, Sørlandet Hospital, Kristiansand, Norway., Tveiten A; Department of Neurology, Sørlandet Hospital, Kristiansand, Norway., Kurz MW; Department of Neurology, Neuroscience Research Group, Stavanger University Hospital, Stavanger, Norway.; Department of Clinical Science, University of Bergen, Bergen, Norway., Kurz KD; Department of Radiology, Stavanger University Hospital, Stavanger, Norway.; Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway., Stokkeland PJ; Department of Radiology, Sørlandet Hospital, Kristiansand, Norway., Hetland HB; Department of Research, Section of Biostatistics, Stavanger University Hospital, Stavanger, Norway., Ersdal HL; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.; Department of Simulation-based Learning, Stavanger University Hospital, Stavanger, Norway., Hyldmo PK; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.; Department of Research, Sørlandet Hospital, Kristiansand, Norway.
Jazyk:	angličtina
Zdroj:	Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences [Interv Neuroradiol] 2024 Sep 05, pp. 15910199241278036. Date of Electronic Publication: 2024 Sep 05.
DOI:	10.1177/15910199241278036
Abstrakt:	Background: Endovascular thrombectomy, the preferred treatment for acute large-vessel occlusion stroke, is highly time-dependent. Many patients live far from thrombectomy centers due to large geographical variations in stroke services. This study aimed to explore the consequences of long transport distance on the proportion of thrombectomy-eligible patients who underwent thrombectomy, the clinical outcomes with or without thrombectomy, the timelines for patients transported, and the diagnostic accuracy of large-vessel occlusion in primary stroke centers. Methods: We conducted a retrospective observational study in a county with only primary stroke centers, ∼ 300 km from the nearest thrombectomy center. All stroke patients admitted over a year were retrieved from the Norwegian Stroke Registry. A neuroradiologist identified all computed tomography images with large-vessel occlusions. A panel determined whether these patients had a corresponding clinical indication for thrombectomy. Results: A total of 50% of the eligible patients did not receive thrombectomy. These patients had a significantly higher risk of severe disability or death compared to the patients who underwent thrombectomy. The median time from computed tomography imaging at the primary stroke center to arrival at the thrombectomy center was over 3 hours. Additionally, 30% of the large-vessel occlusions were initially undiagnosed, and half of these patients had a corresponding clinical indication for thrombectomy. Conclusions: In a county with a long transport distance to a thrombectomy center, a high proportion of eligible patients did not undergo thrombectomy, negatively impacting clinical outcomes. The transport time was considerable. A high rate of large-vessel occlusions was initially not diagnosed. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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