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Interfacility Transfer Directly to the Neuroangiography Suite in Acute Ischemic Stroke Patients Undergoing Thrombectomy.
Jadhav, Ashutosh P; Kenmuir, Cynthia L; Aghaebrahim, Amin; Limaye, Kaustubh; Wechsler, Lawrence R; Hammer, Maxim D; Starr, Matthew T; Molyneaux, Bradley J; Rocha, Marcelo; Guyette, Francis X; Martin-Gill, Christian; Ducruet, Andrew F; Gross, Bradley A; Jankowitz, Brian T; Jovin, Tudor G.
Afiliação
  • Jadhav AP; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Kenmuir CL; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Aghaebrahim A; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Limaye K; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Wechsler LR; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Hammer MD; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Starr MT; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Molyneaux BJ; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Rocha M; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Guyette FX; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Martin-Gill C; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Ducruet AF; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Gross BA; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Jankowitz BT; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
  • Jovin TG; From the Department of Neurology (A.P.J., C.L.K., K.L., L.R.W., M.D.H., M.T.S., B.J.M., M.R., B.A.G., B.T.J., T.G.J.), Department of Neurosurgery (A.P.J., B.J.M., B.A.G., B.T.J., T.G.J.), Department of Critical Care Medicine (B.J.M.), and Department of Emergency Medicine (F.X.G., C.M.-G.), Universit
Stroke ; 48(7): 1884-1889, 2017 07.
Article em En | MEDLINE | ID: mdl-28536177
ABSTRACT
BACKGROUND AND

PURPOSE:

In patients identified at referring facilities with acute ischemic stroke caused by a large vessel occlusion, bypassing the emergency department (ED) with direct transport to the neuroangiography suite may safely shorten reperfusion times.

METHODS:

We conducted a single-center retrospective review of consecutive patients transferred to our facility for consideration of endovascular therapy. Patients were identified as admitted directly to the neuroangiography suite (DAN), transferred to the ED before intra-arterial therapy (ED-IA), and transferred to the ED but did not receive IA therapy (ED-IV).

RESULTS:

A retrospective review of a prospectively maintained database of transfer patients between January 2013 and October 2016 with large vessel occlusions identified 108 ED-IV patients and 261 patients who underwent mechanical thrombectomy (DAN=111 patients and ED-IA=150 patients). There were no differences in baseline characteristics among the 3 groups. The median computed tomography ASPECTS (Alberta Stroke Program Early CT Score) was lower in the ED-IV group versus the ED-IA and DAN groups (8 versus 9; P=0.001). In the DAN versus ED-IA cohort, there were comparable rates of TICI2b/3 recanalization and access to recanalization time. There was significantly faster hospital arrival to groin access time in the DAN cohort (81 minutes versus 22 minutes; P=0.001). Functional independence at 90 days was comparable in the DAN versus ED-IA cohorts but worse in the ED-IV group (43% versus 44% versus 22%; P=0.001).

CONCLUSIONS:

DAN is safe, feasible, and associated with faster times of hospital arrival to recanalization. The clinical benefit of this approach should be assessed in a prospective randomized trial.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Avaliação de Processos e Resultados em Cuidados de Saúde / Admissão do Paciente / Angiografia Cerebral / Isquemia Encefálica / Transferência de Pacientes / Acidente Vascular Cerebral / Serviço Hospitalar de Emergência / Procedimentos Endovasculares / Trombólise Mecânica Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans / Middle aged Idioma: En Revista: Stroke Ano de publicação: 2017 Tipo de documento: Article
Texto completo
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XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Avaliação de Processos e Resultados em Cuidados de Saúde / Admissão do Paciente / Angiografia Cerebral / Isquemia Encefálica / Transferência de Pacientes / Acidente Vascular Cerebral / Serviço Hospitalar de Emergência / Procedimentos Endovasculares / Trombólise Mecânica Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Humans / Middle aged Idioma: En Revista: Stroke Ano de publicação: 2017 Tipo de documento: Article