1
|
Zhai G, Song J, Yu N, Guo C, Liu S, Yue C, Yang D, Xie D, Liu X, Yu S, Lei L. Predictors of Mechanical Thrombectomy for Anterior Circulation Emergent Large-Vessel Occlusion in the Older Adults. Clin Appl Thromb Hemost 2023; 29:10760296231184219. [PMID: 37386776 DOI: 10.1177/10760296231184219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Few studies have reported the clinical outcomes of older adult patients with acute anterior circulation large-vessel occlusion (LVO) who underwent mechanical thrombectomy (MT). Therefore, we investigated the safety, functional outcomes, and predictors of MT for anterior circulation LVO in older adults. We enrolled patients with acute anterior circulation LVO from May 2018 to October 2021 in this retrospective study. Patients were divided into older (≥80 years) and young (<80 years) groups. Multivariable logistic regression analyses determined the safety, functional outcomes, and predictors of MT for anterior circulation LVO. We divided 1182 patients with acute ischemic stroke into young (18-79 years; 1028 patients) and older (≥80 years; 154 patients) groups. Compared with the young group, the older group had more unfavorable functional outcomes and increased mortality (P = .003). In the older adult patients, lower initial NIHSS score and higher ASPECTS were correlated with good outcomes. On the contrary, higher initial NIHSS score and lower ASPECTS were related to increased mortality. No difference was detected in symptomatic intracranial hemorrhage within 48 h between two groups. Increasing age was associated with lower rates of favorable functional outcomes and higher mortality rates. The lower initial NIHSS score combined with the higher ASPECTS may predict functional outcomes post-thrombectomy in older adults.
Collapse
Affiliation(s)
- Guojie Zhai
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Jiaxing Song
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Nizhen Yu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Changwei Guo
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuai Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Chengsong Yue
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dahong Yang
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Dongjing Xie
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiang Liu
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shuye Yu
- Department of Neurology, Suzhou Ninth People's Hospital, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, China
| | - Lei Lei
- Department of Neurology, Xianyang Hospital of Yan'an University, Xianyang, China
| |
Collapse
|
2
|
Rangel I, Palmisciano P, Vanderhye VK, El Ahmadieh TY, Wahood W, Demaerschalk BM, Sands KA, O’Carroll CB, Krishna C, Zimmerman RS, Chong BW, Bendok BR, Turkmani AH. Optimizing Door-to-Groin Puncture Time: The Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2022; 6:327-336. [PMID: 35801155 PMCID: PMC9253412 DOI: 10.1016/j.mayocpiqo.2022.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVES To provide a better understanding of methods that can be used to improve patient outcomes by reducing the door-to-groin puncture (DTP) time and present the results of a stroke quality improvement project (QIP) conducted by Mayo Clinic Arizona's stroke center. METHODS We conducted a systematic literature search of Ovid MEDLINE(R), Ovid EMBASE, Scopus, and Web of Science for studies that evaluated DTP time reduction strategies. Those determined eligible for the purpose of this analysis were assessed for quality. The strategies for DTP time reduction were categorized on the basis of modified Target: Stroke Phase III recommendations and analyzed using a meta-analysis. The Mayo Clinic QIP implemented a single-call activation system to reduce DTP times by decreasing the time from neurosurgery notification to case start. RESULTS Fourteen studies were selected for the analysis, consisting of 2277 patients with acute ischemic stroke secondary to large-vessel occlusions. After intervention, all the studies showed a reduction in the DTP time, with the pooled DTP improvement being the standardized mean difference (1.37; 95% confidence interval, 1.20-1.93; τ2=1.09; P<.001). The Mayo Clinic QIP similarly displayed a DTP time reduction, with the DTP time dropping from 125.1 to 82.5 minutes after strategy implementation. CONCLUSION Computed tomography flow modifications produced the largest and most consistent reduction in the DTP time. However, the reduction in the DTP time across all the studies suggests that any systematic protocol aimed at reducing the DTP time can produce a beneficial effect. The relative novelty of mechanical thrombectomy and the consequential lack of research call for future investigation into the efficacy of varying DTP time reduction strategies.
Collapse
Affiliation(s)
- India Rangel
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Vanesa K. Vanderhye
- Department of Neurology, Mayo Clinic, Phoenix, AZ
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ
| | - Tarek Y. El Ahmadieh
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York City, NY
| | - Waseem Wahood
- Dr. Kiran C. Patel College of Allopathic Medicine, Nova Southeastern University, Davie, FL
| | | | | | | | - Chandan Krishna
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ
| | | | - Brian W. Chong
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ
- Department of Radiology, Mayo Clinic, Phoenix, AZ
| | | | - Ali H. Turkmani
- Department of Neurological Surgery, Mayo Clinic, Phoenix, AZ
- Correspondence: Address to Ali H. Turkmani, MD, Department of Neurological Surgery, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, AZ 85054 9.
| |
Collapse
|
3
|
Kim SH, Nam TM, Jang JH, Kim YZ, Kim KH, Kim DH, Lee H, Jin SC, Lee CH. Improving Door-To-Puncture Time in Mechanical Thrombectomy with Direct Care from a Neurointerventionalist in the Emergency Department. World Neurosurg 2021; 152:e455-e461. [PMID: 34144162 DOI: 10.1016/j.wneu.2021.05.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE A shorter door-to-puncture time is an independent predictor of good clinical outcomes in patients with acute ischemic stroke (AIS) who undergo mechanical thrombectomy (MT). We recently initiated a protocol for direct care from neurointerventionalists (NIs) in the emergency department (ED) rather than from non-NI neurologists for patients with AIS. Our aim was to investigate whether NIs, as the first point-of-care physicians for stroke in the ED, could shorten door-to-puncture time compared to non-NI neurologists. METHODS From January 2020 to December 2020, 50 patients with AIS underwent MT at our hospital. Patients were divided into 2 groups based on the type of physician who provided initial care for stroke in the ED: (a) NI group (n = 20) and (b) non-NI group (n = 30). The door-to-puncture time was retrospectively analyzed. RESULTS The NI group had a significantly shorter door-to-puncture time than the non-NI group (135.2 ± 50.0 minutes vs. 167.2 ± 54.3 minutes, P = 0.040). A door-to-puncture time of ≤120 minutes was more frequently achieved in the NI group than in the non-NI group (55.0% vs. 23.3%, P = 0.022). Multivariable logistic regression analysis revealed that a door-to-puncture time of ≤120 minutes was independently associated with the NI group (adjusted odds ratio 4.098, 95% confidence interval 1.085-15.479, P = 0.037). CONCLUSIONS Our study showed that NIs, as the first point-of-care stroke physicians in the ED, were associated with shorter door-to-puncture times. We suggest that NIs should be at the forefront of care for patients with AIS in the acute setting by performing triage and deciding on and performing MT.
Collapse
Affiliation(s)
- Seung Hwan Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea; Department of Neurosurgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Taek Min Nam
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea; Department of Neurosurgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Ji Hwan Jang
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Young Zoon Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Kyu Hong Kim
- Department of Neurosurgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Do-Hyung Kim
- Department of Neurology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyungon Lee
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Sung-Chul Jin
- Department of Neurosurgery, Inje University Haeundae Paik Hospital, Busan, Republic of Korea
| | - Chul Hee Lee
- Department of Neurosurgery, Gyeongsang National University College of Medicine, Jinju, Republic of Korea.
| |
Collapse
|
4
|
Janssen PM, Venema E, Dippel DW. Effect of Workflow Improvements in Endovascular Stroke Treatment. Stroke 2019; 50:665-674. [DOI: 10.1161/strokeaha.118.021633] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Paula M. Janssen
- From the Department of Neurology (P.M.J., E.V., D.W.J.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Esmee Venema
- From the Department of Neurology (P.M.J., E.V., D.W.J.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
- Department of Public Health (E.V.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Diederik W.J. Dippel
- From the Department of Neurology (P.M.J., E.V., D.W.J.D.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|