[To optimize the initial assessment for stroke patients transferred from general hospital may improve the clinical outcome after endovascular thrombectomy]

Clinical Outcomes of Mechanical Thrombectomy for Acute Ischemic Stroke in Transfer Cases

Objective

There are regional disparities in endovascular thrombectomy, and problems with emergency transport systems and hospital collaboration when transferring need to be addressed. In this study, the clinical outcomes of endovascular thrombectomy for transferred patients were analyzed.

Methods

Acute ischemic stroke patients who underwent endovascular thrombectomy between January 2016 and March 2019 were enrolled. They were retrospectively reviewed and divided into the direct group and transfer group, and we compared treatment results and clinical outcomes between them.

Results

In all, 122 patients met the inclusion criteria, comprising 93 patients in the direct group and 29 patients in the transfer group. The time from onset to door of our hospital was longer in the transfer group than in the direct group (73 minutes vs. 158 minutes, P = 0.80), but the time from arrival to reperfusion was significantly shorter in the transfer group (139 minutes vs. 106 minutes, P = 0.001). As the time from onset to reperfusion did not differ significantly between the two groups (220 minutes vs. 256 minutes, P = 0.60), there was no significant difference in good outcome at discharge (38.7 vs. 41.3%, P = 0.79).

Conclusion

Clinical outcomes of transferred patients for endovascular thrombectomy may be equivalent to those of directly transported patients. Promoting close hospital cooperation may improve clinical outcomes and resolve regional disparities.

Reducing door-to-reperfusion time in acute stroke endovascular therapy using magnetic resonance imaging as a screening modality

Background

The feasibility of performing MRI first for patients with suspected hyperacute stroke in real-world practice has not been fully examined. Moreover, most past studies of reducing door-to-reperfusion time (DRT) in endovascular treatment (EVT) were conducted using CT. The aim of this study was to evaluate the feasibility of an MRI-first policy and to examine the effects of a quality improvement (QI) process for reducing DRT using MRI.

Methods

From January 2013 to December 2018, consecutive patients with acute stroke who came to hospital directly and were treated with emergent EVT were prospectively enrolled into the present study. In principle, MRI was performed first for patients with suspected acute stroke. A step-by-step QI process for decreasing DRT was adopted during this period. Time metrics for EVT were compared between specific time periods.

Results

A total of 180 patients (71 women; median age 76 years (range 69–64); National Institutes of Health Stroke Scale score 17 (range 10–23)) were included in the present study. More patients in the late phase were managed with the MRI-first policy (p<0.001). DRT (199 min in Phase 1, 135 min in Phase 2, 129 min in Phase 3, and 121 min in Phase 4, p<0.001) was significantly reduced across the phases. The percentage of patients with DRT <120 min increased significantly across time periods (p<0.001). Symptomatic intracerebral hemorrhage did not increase across phases (p=0.575).

Conclusion

An MRI-first policy was feasible, and DRT decreased considerably with a step-by-step QI process. This process may be applicable to other hospitals.