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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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A regional strategy to decrease the time to thrombectomy in patients with low probability of treatment by
A Ter Schiphorst1, C Duflos2, I Mourand1
1Department of Neurology, CHRU Gui de Chauliac, Montpellier, France.
Revue Neurologique
|December 14, 2021
Summary
A new direct transport strategy significantly reduced mechanical thrombectomy times for suspected large vessel occlusion (LVO) patients. This approach optimized stroke care without delaying intravenous thrombolysis (IVT).
Area of Science:
- Neurology
- Emergency Medicine
- Vascular Surgery
Background:
- Optimal transportation strategies for suspected large vessel occlusion (LVO) remain unclear.
- Current methods often involve delays in treatment initiation for stroke patients.
Purpose of the Study:
- To evaluate a novel regional transportation strategy for LVO patients.
- To assess direct transport to Comprehensive Stroke Centers (CSCs) for patients with low likelihood of immediate treatment at Primary Stroke Centers (PSCs).
Main Methods:
- A pre-hospital bypass criteria was established for direct CSC transport.
- Criteria included high LVO probability and low intravenous thrombolysis (IVT) probability, or minimal travel time difference.
- Treatment times were compared between direct bypass and traditional 'drip-and-ship' groups.
Main Results:
- Direct routing decreased time to groin puncture by 55 minutes for LVO patients meeting bypass criteria.
- The strategy successfully identified LVO cases.
- Time to IVT was not significantly increased by the direct transport strategy.
Conclusions:
- The evaluated regional strategy effectively identifies LVO.
- Direct transportation significantly reduces time to mechanical thrombectomy.
- This approach is implementable in other regions to improve stroke care efficiency.
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