Real-world treatment of large vessel occlusions: combined outcomes of directly presenting and transferred-in patients to a stroke center
| Autor: | Ganesh Asaithambi, Emily H Marino, Bridget M Ho, Amy L. Castle, Lana J. Stein, Sandra K. Hanson, Andrew C. Wallace-Jackson, Jeffrey P Lassig |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Patient Transfer medicine.medical_specialty Target vessel Large vessel Time-to-Treatment 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Modified Rankin Scale medicine.artery medicine Basilar artery Humans In patient 030212 general & internal medicine Prospective Studies Endovascular treatment Stroke Aged Retrospective Studies Groin business.industry Endovascular Procedures General Medicine medicine.disease Surgery medicine.anatomical_structure Treatment Outcome Neurology Tissue Plasminogen Activator Administration Intravenous Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Neurological research. 40(8) |
| ISSN: | 1743-1328 |
| Popis: | Background Stroke patients transferred in for endovascular treatment (ET) may have lower chances for favorable outcomes compared to those who presented directly to a ET-capable hospital. We describe our real-world experience of ET in AIS, especially among patients transferred in. Materials and methods AIS patients receiving ET from January 2015 to November 2016 were reviewed. We calculated median onset to groin puncture (OTP) and groin puncture to recanalization times (PTR), location of target vessel treated, rate of concurrent intravenous (IV) alteplase use, and rate of successful recanalization as defined by TICI ≥ 2b. Outcomes included discharge disposition to nursing home (NH) and 90-day modified Rankin Scale (mRS) scores. Results We identified 174 patients (50.6% women, mean age 69.5 ± 15.7 years, 49.4% transfer-ins) undergoing ET (20.5% terminal internal carotid artery, 47.7% M1, 17% M2, 9.2% basilar artery, 5.7% other). Median OTP and PTR times were 257 [158, 375] and 30 [22, 48] minutes, respectively. Rate of TICI ≥ 2b was 82.9%, and 55.7% received adjunctive IV alteplase. Rate of discharge to NH was 17.2% 90-day mRS ≤ 2 was 41.7%. Discharge to NH (P = 0.32) and 90-day mRS ≤ 2 (P = 0.75) were not significantly different between transferred in versus direct presentation patients. Conclusion High rates of favorable angiographic and clinical outcomes were found among AIS patients receiving ET in our single-center experience, particularly among transferred in patients. The establishment of a stroke network may help in the efficient transfer and assembly of appropriate resources for eligible patients that are transferred in for ET. |
| Databáze: | OpenAIRE |
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