Delayed Thrombectomy Center Arrival is Associated with Decreased Treatment Probability

被引：4

作者：

Gao, Meah M. ^{[1
]}

Wang, Jeffrey Z. ^{[1
]}

Liao, Jane ^{[1
]}

Reiter, Stephanie D. ^{[1
]}

Vyas, Manav V. ^{[1
,2
,3
]}

Linkewich, Elizabeth ^{[2
,6
]}

Swartz, Richard H. ^{[1
,2
]}

da Costa, Leodante ^{[2
,4
]}

Kassardjian, Charles D. ^{[1
,5
]}

Yu, Amy Y. X. ^{[1
,2
]}

机构：

[1] Univ Toronto, Dept Med Neurol, 5W West Toronto Western Hosp, Toronto, ON, Canada

[2] Sunnybrook Hlth Sci Ctr, Toronto, ON, Canada

[3] Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[4] Univ Toronto, Dept Surg, Toronto, ON, Canada

[5] St Michaels Hosp, Toronto, ON, Canada

[6] Univ Toronto, Dept Occupat Sci & Occupat Therapy, Toronto, ON, Canada

来源：

CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES | 2020年 / 47卷 / 06期

基金：

加拿大健康研究院;

关键词：

Stroke; Endovascular; Health services research; ACUTE ISCHEMIC-STROKE; INTRAARTERIAL TREATMENT; ENDOVASCULAR TREATMENT; INTERHOSPITAL TRANSFER; OUTCOMES; THERAPY; TIME;

D O I：

10.1017/cjn.2020.95

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background: Endovascular thrombectomy (EVT) is effective in reducing disability in selected patients with stroke and large vessel occlusion (LVO), but access to this treatment is suboptimal. Aim: We examined the proportion of patients with LVO who did not receive EVT, the reasons for non-treatment, and the association between time from onset and probability of treatment. Methods: We conducted a retrospective cohort study of consecutive patients with acute stroke and LVO presenting between January 2017 and June 2018. We used multivariable log-binomial models to determine the association between time and probability of treatment with and without adjustment for age, sex, dementia, active cancer, baseline disability, stroke severity, and evidence of ischemia on computerized tomography. Results: We identified 256 patients (51% female, median age 74 [interquartile range, IQR 63.5, 82.5]), of whom 59% did not receive EVT. The main reasons for not treating with EVT were related to occlusion characteristics or infarct size. The median time from onset to EVT center arrival was longer among non-treated patients (218 minutes [142, 302]) than those who were treated (180 minutes [104, 265], p = 0.03). Among patients presenting within 6 hours of onset, the relative risk (RR) of receiving EVT decreased by 3% with every 10-minute delay in arrival to EVT center (adjusted RR 0.97 CI95 [0.95, 0.99]). This association was not found in the overall cohort. Conclusions: The proportion of patients with acute stroke and confirmed LVO who do not undergo EVT is substantial. Minimizing delays in arrival to EVT center may optimize the delivery of this treatment.

引用

页码：770 / 774

页数：5

共 20 条

[1] Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].

Albers, G. W. ;

Marks, M. P. ;

Kemp, S. ;

Christensen, S. ;

Tsai, J. P. ;

Ortega-Gutierrez, S. ;

McTaggart, R. A. ;

Torbey, M. T. ;

Kim-Tenser, M. ;

Leslie-Mazwi, T. ;

Sarraj, A. ;

Kasner, S. E. ;

Ansari, S. A. ;

Yeatts, S. D. ;

Hamilton, S. ;

Mlynash, M. ;

Heit, J. J. ;

Zaharchuk, G. ;

Kim, S. ;

Carrozzella, J. ;

Palesch, Y. Y. ;

Demchuk, A. M. ;

Bammer, R. ;

Lavori, P. W. ;

Broderick, J. P. ;

Lansberg, M. G. .

NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718

[2] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[3] Clinical Imaging Factors Associated With Infarct Progression in Patients With Ischemic Stroke During Transfer for Mechanical Thrombectomy [J].

Boulouis, Gregoire ;

Lauer, Arne ;

Siddiqui, Ahmer Khawdja ;

Charidimou, Andreas ;

Regenhardt, Robert W. ;

Viswanathan, Anand ;

Rost, Natalia ;

Leslie-Mazwi, Thabele M. ;

Schwamm, Lee H. .

JAMA NEUROLOGY, 2017, 74 (11) :1361-1367

[4] Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke The Madrid Stroke Network Experience [J].

Fuentes, Blanca ;

Alonso de Lecinana, Maria ;

Ximenez-Carrillo, Alvaro ;

Martinez-Sanchez, Patricia ;

Cruz-Culebras, Antonio ;

Zapata-Wainberg, Gustavo ;

Ruiz-Ares, Gerardo ;

Frutos, Remedios ;

Fandino, Eduardo ;

Caniego, Jose L. ;

Fernandez-Prieto, Andres ;

Mendez, Jose C. ;

Barcena, Eduardo ;

Marin, Begona ;

Garcia-Pastor, Andres ;

Diaz-Otero, Fernando ;

Gil-Nunez, Antonio ;

Masjuan, Jaime ;

Vivancos, Jose ;

Diez-Tejedor, Exuperio .

STROKE, 2015, 46 (08) :2156-2161

[5] Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[6] Primary to comprehensive stroke center transfers: Appropriateness, not futility [J].

Goyal, Mayank ;

Menon, Bijoy K. ;

Wilson, Alexis T. ;

Almekhlafi, Mohammed A. ;

McTaggart, Ryan ;

Jayaraman, Mahesh ;

Demchuk, Andrew M. ;

Hill, Michael D. .

INTERNATIONAL JOURNAL OF STROKE, 2018, 13 (06) :550-553

[7] Association Between Time to Treatment With Endovascular Reperfusion Therapy and Outcomes in Patients With Acute Ischemic Stroke Treated in Clinical Practice [J].

Jahan, Reza ;

Saver, Jeffrey L. ;

Schwamm, Lee H. ;

Fonarow, Gregg C. ;

Liang, Li ;

Matsouaka, Roland A. ;

Xian, Ying ;

Holmes, DaJuanicia N. ;

Peterson, Eric D. ;

Yavagal, Dileep ;

Smith, Eric E. .

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2019, 322 (03) :252-263

[8] Endovascular treatment for acute ischaemic stroke in routine clinical practice: prospective, observational cohort study (MR CLEAN Registry) [J].

Jansen, Ivo G. H. ;

Mulder, Maxim J. H. L. ;

Goldhoorn, Robert-Jan B. ;

Emmer, Bart J. ;

van Es, Adriaan C. G. M. ;

Roozenbeek, Bob ;

Schonewille, Wouter J. ;

van den Berg, Rene ;

Coutinho, Jonathan M. ;

Staals, Julie ;

Postma, Alida A. ;

Lycklama, Geert J. ;

Hofmeijer, Jeannette ;

Martens, Jasper M. ;

den Hertog, Heleen M. ;

Sturm, Fmiel J. C. ;

van der Worp, H. Bart ;

Lo, Rob H. ;

Heijboer, Roel J. J. ;

Keizer, Koos ;

Uyttenboogaart, Maarten ;

Eshghi, Omid ;

Wermer, Marieke J. H. ;

van Walderveen, Marianne A. A. ;

van Dijk, Ewoud J. ;

Boogaarts, Hieronymus D. ;

de Bruijn, Sebastiaan F. ;

van Dijk, Lukas C. ;

van den Berg, Jan S. P. ;

van Hasselt, Boudewijn A. A. M. ;

de Kort, Paul L. M. ;

Peluso, Jo P. P. ;

Schreuder, Tobien H. C. M. L. ;

Aerden, Leo A. M. ;

Dallinga, Rene J. ;

Sprengers, Marieke E. S. ;

Yo, Lonneke S. F. ;

Jenniskens, Sjoerd F. M. ;

Roosendaal, Stefan D. ;

van der Kallen, Bas F. W. ;

van den Wijngaard, Ido R. ;

Bot, Joost C. J. ;

van Doormaal, Pieter J. ;

Flach, H. Zwenneke ;

Venema, Esmee ;

Lingsma, Hester F. ;

Beenen, Ludo F. M. ;

Yoo, Albert J. ;

Boiten, Jelis ;

Vos, Jan A. .

BMJ-BRITISH MEDICAL JOURNAL, 2018, 360

[9] Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature [J].

Lakomkin, Nikita ;

Dhamoon, Mandip ;

Carroll, Kirsten ;

Singh, Inder Paul ;

Tuhrim, Stanley ;

Lee, Joyce ;

Fifi, Johanna T. ;

Mocco, J. .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2019, 11 (03) :241-245

[10] ASPECTS decay during inter-facility transfer in patients with large vessel occlusion strokes [J].

Mokin, Maxim ;

Gupta, Rishi ;

Guerrero, Waldo R. ;

Rose, David Z. ;

Burgin, William S. ;

Sivakanthan, Sananthan .

JOURNAL OF NEUROINTERVENTIONAL SURGERY, 2017, 9 (05) :442-444

← 1 2 →