Progression of cerebral infarction before and after thrombectomy is modified by prehospital pathways
| Autor: | Alexander M. Kollikowski, Guido Stoll, Franziska Weidner, Mirko Pham, Julia Haag, Jörn Feick, Michael K. Schuhmann, Marc Strinitz, Wolfgang Müllges, Alexander G. März, Franziska Cattus |
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| Rok vydání: | 2021 |
| Předmět: |
Emergency Medical Services
medicine.medical_specialty Stroke severity Infarction Patient characteristics Arterial Occlusive Diseases 030204 cardiovascular system & hematology Brain Ischemia 03 medical and health sciences 0302 clinical medicine Internal medicine Humans Medicine Stroke Ischemic Stroke Retrospective Studies Thrombectomy business.industry Cerebral infarction Cerebral Infarction General Medicine Methods aspects medicine.disease Mechanical thrombectomy Treatment Outcome Cardiology Surgery Neurology (clinical) business 030217 neurology & neurosurgery Large vessel occlusion |
| Zdroj: | Journal of NeuroInterventional Surgery. 14:485-489 |
| ISSN: | 1759-8486 1759-8478 |
| DOI: | 10.1136/neurintsurg-2020-017155 |
| Popis: | BackgroundEvidence of the consequences of different prehospital pathways before mechanical thrombectomy (MT) in large vessel occlusion stroke is inconclusive. The aim of this study was to investigate the infarct extent and progression before and after MT in directly admitted (mothership) versus transferred (drip and ship) patients using the Alberta Stroke Program Early CT Score (ASPECTS).MethodsASPECTS of 535 consecutive large vessel occlusion stroke patients eligible for MT between 2015 to 2019 were retrospectively analyzed for differences in the extent of baseline, post-referral, and post-recanalization infarction between the mothership and drip and ship pathways. Time intervals and transport distances of both pathways were analyzed. Multiple linear regression was used to examine the association between infarct progression (baseline to post-recanalization ASPECTS decline), patient characteristics, and logistic key figures.ResultsASPECTS declined during transfer (9 (8–10) vs 7 (6-9), p<0.0001). After multivariable adjustment, only interfacility transfer, preinterventional clinical stroke severity, the degree of angiographic recanalization, and the duration of the thrombectomy procedure remained predictors of infarct progression (R2=0.209, p<0.0001).ConclusionsInfarct progression and postinterventional infarct extent, as assessed by ASPECTS, varied between the drip and ship and mothership pathway, leading to more pronounced infarction in transferred patients. ASPECTS may serve as a radiological measure to monitor the benefit or harm of different prehospital pathways for MT. |
| Databáze: | OpenAIRE |
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