Do current logistics ensure better odds and outcome in acute large vessel occlusion patients?

Czech version

Authors: D. Krajíčková ¹; A. Krajina ²; E. Vítková ¹; S. Halúsková ¹; O. Vyšata ¹; R. Herzig ¹
Authors‘ workplace: Neurologická klinika, Komplexní cerebrovaskulární centrum LF UK a FN Hradec Králové ¹; Radiologická klinika, Komplexní cerebrovaskulární centrum LF UK a FN Hradec Králové ²
Published in: Cesk Slov Neurol N 2018; 81(3): 338-344
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2018338

Tato studie byla částečně podpořena grantovými projekty MZ ČR (FN HK 00179906) a Univerzity Karlovy (PROGRES Q40).

Overview

Aim:
The chance of a good result of mechanical thrombectomy (MT) for a large cerebral artery occlusion is directly proportional to the speed of its execution. The aim was to find differences in outcome in patients transported primarily and secondarily to the Comprehensive Stroke Center (CSC) of the University Hospital Hradec Králové.

Patients and Methods:
Out of 258 consecutive patients, 171 were transported to the CSC for MT primarily and 87 secondarily, from the primary stroke center. Clinical data, including intervals from the onset of cerebral ischemia and arrival to the center and then to treatment, were compared with clinical trials and the STRATIS registry and in both groups. The indicator of treatment effectiveness was the achievement of successful recanalization (TICI ≥ 2b) and self-sufficiency in 3 months (mRS ≤ 2).

Results:
Despite the fact that in secondarily transported patients MT was started and completed significantly later (271.7 ± 96.8 min vs. 175.7 ± 63.9 min, and 321.3 ± 107.6 min vs. 226.4 ± 72.3 min, resp.; both p < 0.0001), these patients had a statistically insignificant tendency towards a higher proportion of self-sufficiency (63.2 vs. 46.8%) and lower mortality (14.9 vs. 21.1%). They were statistically significantly younger (68.8 ± 13.2 vs. 73.4 ± 12.8 years; p = 0.007), with a lower proportion of patients > 80 years (17.0 vs. 33.3%; p = 0.043) and a higher proportion of tandem pathologies (24.1 vs. 11.7%; p = 0.036).

Conclusion:
Our results suggest that selection associated with secondary transport excludes a group of more risky patients from endovascular treatment.

Key words:
ischemic stroke – anterior circulation – mechanical thrombectomy – secondary transport – fast progressors – slow progressors – recanalization – clinical outcome

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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