Endovascular Treatment of Acute Ischemic Stroke in Clinical Practice: Analysis of Workflow and Outcome in a Tertiary Care Center
| Autor: | Gerrit M. Grosse, Karin Weissenborn, Friedrich Götz, Sam Gruber, Omar Abu-Fares, Ramona Schuppner, Hans Worthmann, Maria M. Gabriel |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
acute ischemic stroke
medicine.medical_specialty medicine.medical_treatment Outcome (game theory) Modified Rankin Scale onset-to-groin-time Medicine RC346-429 Acute ischemic stroke Stroke Original Research business.industry Cerebral infarction Thrombolysis mechanical recanalization medicine.disease work-flow Workflow Neurology Emergency medicine outcome Vomiting Neurology. Diseases of the nervous system Neurology (clinical) medicine.symptom business |
| Zdroj: | Frontiers in Neurology Frontiers in Neurology, Vol 12 (2021) |
| ISSN: | 1664-2295 |
| Popis: | Background and Purpose: Pre- and intra-hospital workflow in mechanical recanalization of large cervicocephalic arteries in patients with acute ischemic stroke still needs optimization. In this study, we analyze workflow and outcome in our routine care of stroke patients undergoing mechanical thrombectomy as a precondition for such optimization.Methods: Processes of pre- and intra-hospital management, causes of treatment delay, imaging results (Alberta Stroke Program Early Computed Tomography Score, localization of vessel occlusion), recanalization (modified thrombolysis in cerebral infarction score), and patient outcome (modified Rankin scale at discharge and at the end of inpatient rehabilitation) were analyzed for all patients who underwent mechanical thrombectomy between April 1, 2016, and September 30, 2018, at our site.Results: Finally, data of 282 patients were considered, of whom 150 (53%) had been referred from external hospitals. Recanalization success and patient outcome were similar to randomized controlled thrombectomy studies and registries. Delay in treatment occurred when medical treatment of a hypertensive crisis, epileptic fits, vomiting, or agitation was mandatory but also due to missing prenotification of the hospital emergency staff by the rescue service, multiple mode or repeated brain imaging, and transfer from another hospital. Even transfer from external hospitals located within a 10-km radius of our endovascular treatment center led to a median increase of the onset-to-groin time of ~60 min.Conclusion: The analysis revealed several starting points for an improvement in the workflow of thrombectomy in our center. Analyses of workflow and treatment results should be carried out regularly to identify the potential for optimization of operational procedures and selection criteria for patients who could benefit from endovascular treatment. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|