Drip and ship for mechanical thrombectomy within the Neurovascular Network of Southwest Bavaria.
Neurology
; 94(5): e453-e463, 2020 02 04.
Article
en En
| MEDLINE
| ID: mdl-31831595
ABSTRACT
OBJECTIVE:
To determine feasibility and safety of stroke care organization within our Neurovascular Network of Southwest Bavaria (NEVAS) in a rural area with distances of up to 100 kilometers, we compared patients who underwent mechanical thrombectomy (MT) in large vessel occlusion admitted directly to our center (direct to center [DTC]) to patients who were transferred for MT via NEVAS (drip and ship [DS]).METHODS:
This is a retrospective analysis of prospectively collected data of all MT patients between January 2015 and May 2018. Successful recanalization was defined as a thrombolysis in cerebral infarction score of 2b-3. Symptomatic intracerebral hemorrhage (sICH) was defined according to European Cooperative Acute Stroke Study 3. Modified Rankin Scale (mRS) score of 0-2 at 3 months indicated good outcome.RESULTS:
MT was performed in 410 patients 221 DTC and 189 DS. Median NIH Stroke Scale (NIHSS) score was 16 and premorbid mRS score was 0. Thrombolysis was applied in 62.2% with the same time from symptom onset in both groups (94.5 vs 95 minutes). Successful recanalization (79.3% vs 77.8%) and NIHSS score reduction from admission to discharge (16-7 vs 17-6) were comparable. Time delay from onset to revascularization was 96 minutes in DS (212 vs 308 minutes, p = 0.001). At follow-up, DTC patients had a trend to better outcome (33.5% vs 24.3%, p = 0.056). Neither sICH (6.3% vs 5.9%, p = 0.840) nor mortality (31.2% vs 34.4%, p = 0.387) differed between the groups.CONCLUSION:
DS patients benefit from MT without relevant safety concerns, but with a trend to unfavorable outcome compared to DTC patients. These results suggest that DS is suitable to provide MT in rural areas where DTC is not possible.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
11_ODS3_cobertura_universal
/
2_ODS3
/
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
11_delivery_arrangements
/
2_cobertura_universal
/
6_cardiovascular_diseases
/
6_cerebrovascular_disease
Asunto principal:
Terapia Trombolítica
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Transferencia de Pacientes
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Trombectomía
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Accidente Cerebrovascular
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Atención a la Salud
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
/
Sysrev_observational_studies
Aspecto:
Determinantes_sociais_saude
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Implementation_research
Límite:
Aged
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Aged80
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Female
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Humans
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Male
/
Middle aged
País/Región como asunto:
Europa
Idioma:
En
Revista:
Neurology
Año:
2020
Tipo del documento:
Article