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For patients with acute ischemic stroke caused by large artery occlusion (LAO) , intravenous thrombolytic therapy alone may not be enough to achieve functional independence
.
In selected patients, a blood vessel within the thrombus resection (the EVT) within 24 hours of symptom onset is very effective
Stroke blood clot
Intravascular thrombectomy is limited to comprehensive stroke centers (CSCs) capable of thrombectomy
.
Studies have shown that it is important for eligible patients to be transferred directly to CSC, because studies have shown that patients who have not passed through the primary stroke center (PSC) for a second transfer have faster treatment and better results
Because studies have shown that patients who have not been transferred to the primary stroke center (PSC) for a second time have faster treatment and better results
In the former group, the main driving force for better results appears to be the 59 minutes reduction in the time from on-site departure to arterial puncture for EVT
.
The Stockholm region (population 2.
The system combines the prehospital assessment of hemiplegia with the remote consultation from the ambulance to the hospital, and diverts LAO cases that are most likely to meet the EVT conditions to the CSC
.
In the first year after implementation, the time from the onset of EVT to puncture was reduced from 206 minutes to 137 minutes
In this way, Boris Keselman of Karolinska University Hospital and others compared the results of patients after using SSTS in the previous two years with the EVT treatment using the pre-hospital system in the previous two years
.
They prospectively recruited patients in the Stockholm area who were transported by Code Stroke ambulances under the SSTS and received EVT treatment from October 2017 to October 2019, and compared them with EVT patients in the previous two years
.
Modified Rankin Scale (mRS) score conversion, mRS score 0 to 1, mRS score 0 to 2, and death (all 3 months), National Institutes of Health Stroke Scale (NIHSS) score 24 hours after EVT Changes in reocclusion (cerebral infarction thrombolysis 2b-3), and symptomatic intracranial hemorrhage, mRS results were adjusted according to age and baseline NIHSS
.
They found that compared with the historical control group (n=187), EVT patients in the SSTS group (n=244) were older and had a higher baseline NIHSS: median age 74 years (interquartile range, 63-81) , While the historical control group was 71 years old (61-78); the NIHSS score was 17 (11.
5-21), and the historical control group was 15 (10-20)
.
During SSTS, the median time from onset to puncture was 136 minutes, vs.
205 minutes (P<0.
001)
.
During the SSTS, 83/240 (34.
6%) and 44/186 (23.
7%) achieved 3-month mRS scores of 0 to 1 (P=0.
014), and the adjusted common OR was 2.
3 (95% CI, 1.
4-3.
6) )
.
The median change of NIHSS at 24 hours after EVT was 6vs4 (P=0.
005)
.
There is no significant difference in thrombolytic treatment of cerebral infarction, symptomatic intracranial hemorrhage and death
The time from onset to arterial puncture was shortened by 69 minutes.
After the implementation of the aortic occlusion shunt system in the entire region, the results of patients treated with thrombectomy were significantly improved
.
These results deserve to be replicated in other regions and organizational settings
The time from onset to arterial puncture was shortened by 69 minutes.
Original source:
Keselman B, Berglund A, Ahmed N, et al.
The Stockholm Stroke Triage Project: Outcomes of Endovascular Thrombectomy Before and After Triage Implementation .
The Stockholm Stroke Triage Project: Outcomes of Endovascular Thrombectomy Before and After Triage ImplementationLeave a message here
