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Outcomes after Thrombectomy in Belfast: Mothership and Drip-and-Ship in the Real World.
Adams, Karen M; Burns, Paul A; Hunter, Annemarie; Rennie, Ian; Flynn, Peter A; Smyth, Graham; Gordon, Patricia L; Patterson, Cathy E; Fearon, Patricia; Kerr, Enda L F; Wiggam, M Ivan.
Afiliação
  • Adams KM; Department of Stroke Medicine, Royal Victoria Hospital, Belfast, United Kingdom, karen.adams@belfasttrust.hscni.net.
  • Burns PA; Department of Neuroradiology, Royal Victoria Hospital, Belfast, United Kingdom.
  • Hunter A; Department of Neurology, Royal Victoria Hospital, Belfast, United Kingdom.
  • Rennie I; Department of Neuroradiology, Royal Victoria Hospital, Belfast, United Kingdom.
  • Flynn PA; Department of Neuroradiology, Royal Victoria Hospital, Belfast, United Kingdom.
  • Smyth G; Department of Neuroradiology, Royal Victoria Hospital, Belfast, United Kingdom.
  • Gordon PL; Department of Stroke Medicine, Royal Victoria Hospital, Belfast, United Kingdom.
  • Patterson CE; Department of Stroke Medicine, Royal Victoria Hospital, Belfast, United Kingdom.
  • Fearon P; Department of Stroke Medicine, Royal Victoria Hospital, Belfast, United Kingdom.
  • Kerr ELF; Department of Stroke Medicine, Royal Victoria Hospital, Belfast, United Kingdom.
  • Wiggam MI; Department of Stroke Medicine, Royal Victoria Hospital, Belfast, United Kingdom.
Cerebrovasc Dis ; 47(5-6): 231-237, 2019.
Article em En | MEDLINE | ID: mdl-31212294
ABSTRACT

BACKGROUND:

Mechanical thrombectomy has revolutionised the treatment of acute ischaemic stroke due to large vessel occlusion. It is well recognised that patients are more likely to benefit when reperfusion happens quickly, however, there is uncertainty as to how best to deliver this service.

OBJECTIVES:

To compare outcomes of patients in Northern -Ireland who underwent thrombectomy via direct admission to the single endovascular centre (mothership [MS]) with those transferred from primary stroke centres (drip-and-ship [DS]).

METHODS:

Analysis was conducted on the records of all patients who underwent thrombectomy from January 2014 to December 2017 inclusive. The primary outcome measure was 3 months functional independence (modified Rankin Score [mRS] 0-2). Secondary outcome measures were full recovery (mRS 0) at 3 months, symptomatic intracranial haemorrhage (sICH) rates and mortality rates.

RESULTS:

Two hundred fourteen patients underwent thrombectomy (MS 124, DS 90). Patients in the MS group were older (median 73 vs. 70 years, p = 0.026), but there was no significant difference in baseline National Institutes of Health Stroke Scale (median 15 MS vs. 16.5 DS, p = 0.162) or thrombolysis rates (41.9% MS vs. 54.4% DS, p = 0.070) between the groups. Time from stroke onset to arrival at thrombectomy centre was shorter in the MS group (median 71 vs. 218 min, p < 0.001) but door to groin puncture time was shorter in the DS group (median 30 vs. 60 min, p < 0.001). There was no significant difference in 3 months functional independence (51.6% MS vs. 62.2% DS, p = 0.123), or in the secondary outcome measures of full recovery (21.8% MS vs. 12.2% DS, p = 0.071), sICH (MS 0.8%, DS 4.4%, p = 0.082) and mortality (MS 24.2%, DS 20.0%, p = 0.468).

CONCLUSIONS:

Our analysis showed similar outcomes after thrombectomy in the MS and DS groups. For patients potentially eligible for thrombectomy, rapid access to the endovascular centre is essential to optimise both the number of patients treated and the outcomes achieved.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Admissão do Paciente / Terapia Trombolítica / Isquemia Encefálica / Transferência de Pacientes / Trombectomia / Acidente Vascular Cerebral / Procedimentos Endovasculares / Tempo para o Tratamento Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2019 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Admissão do Paciente / Terapia Trombolítica / Isquemia Encefálica / Transferência de Pacientes / Trombectomia / Acidente Vascular Cerebral / Procedimentos Endovasculares / Tempo para o Tratamento Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Região como assunto: Europa Idioma: En Ano de publicação: 2019 Tipo de documento: Article