分级转运与会诊治疗模式对急性大血管闭塞性脑卒中血管内治疗效率与疗效的影响

Efficiency and efficacy of"drip-and-ship"and"trip-and-treat"on endovascular treatment of acute ischemic stroke with large vessel occlusion

目的探讨急性大血管闭塞性脑卒中患者采用两种不同转运模式——患者从初级卒中中心转诊至高级卒中中心(分级转运)和神经介入医师从高级卒中中心至初级卒中中心(会诊治疗)行血管内治疗的效率与疗效。方法回顾性分析2017年2月至2019年12月我院及卒中联盟医院内接受血管内治疗的急性前循环大血管闭塞性脑卒中患者临床资料。根据患者转运模式,分为分级转运组与会诊治疗组。主要观察指标为患者到初级卒中中心就诊至血管再通时间,次要观察指标为股动脉穿刺至血管开通时间、取栓后成功再通率、90 d良好预后率。结果分级转运组63例和会诊治疗组33例患者纳入本研究。分级转运组患者就诊至血管再通时间明显长于会诊治疗组患者[(310.7±80.6)min vs(247.3±67.7)min,t=0.458,P<0.05],但股动脉穿刺至血管开通时间短[(77.7±45.2)min vs(119.9±67.0)min,t=-3.256,P<0.05]。分级转运组和会诊治疗组患者机械取栓后成功再灌注比例无统计学差异(90.5%vs 87.9%,χ^(2)=0.157,P=0.732);分级转运及会诊治疗两组病例的良好预后率分别为47.6%和66.7%(χ^(2)=3.165,P=0.075),均无统计学差异。结论急性前循环大血管闭塞性脑卒中患者采用会诊治疗模式接受机械取栓治疗较分级转运模式具有更高的救治效率,但临床预后并未显著优于分级转运模式,这可能与本研究样本量偏小有关。

Objective Patients with acute ischemic stroke(AIS)caused by large vessel occlusion(LVO)are usually transferred from primary stroke center(PSC)to comprehensive stroke center(CSC)for endovascular treatment(drip-and-ship,DS).While driving the doctor from CSC to PSC to perform procedure is an alternative strategy(trip-and-treat,TT).We aimed to compare the efficacy and prognosis of the two strategies.Methods From February 2017 to December 2019,patients with LVO in the anterior circulation received endovascular treatment via DS and TT systems,were retrospectively analyzed from the stroke alliance based on our stroke center.Primary endpoint was door-to-recanalizationtime(DRT).Secondary endpoints included puncture-to-recanalization time(PRT),modified Thrombolysis in Cerebral Infarction(mTICI)rates at the end of procedure,and modified Rankin Scale(mRS)at 90 days.Results Sixty-three patients received treatment in DS group,and 33 patients in TT group.Although the PRT time was shorter than that in TT group[(77.7±45.2)min vs(119.9±67.0)min,t=-3.256,P<0.05],the DRT was significantly longer in DS group[(310.7±80.6)min vs(247.3±67.7)min,t=0.458,P<0.05].Successful recanalization(mTICI 2b/3)was achieved in 90.5%(57/63)of patients in DS group and 87.9%(29/33)in TT group(χ^(2)=0.157,P=0.732).Favorable functional outcomes(mRS 0-2)were observed in 47.6%(30/63)of patients in DS group and 66.7%(22/33)in TT group at 90 days(χ^(2)=3.165,P=0.075).Conclusions With the comparison of DS strategy,TT manner showed more effective and a trend of better clinical outcomes for AIS patients with LVO in the anterior circulation.