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Clinical Outcome After Mechanical Thrombectomy in Non-elderly Patients with Acute Ischemic Stroke in the Anterior Circulation: Primary Admission Versus Patients Referred from Remote Hospitals.
Pfaff, J; Pham, M; Herweh, C; Wolf, M; Ringleb, PA; Schonenberger, S; Bendszus, M; Mohlenbruch, M
Clin Neuroradiol. 2017; 27(2):185-192
Originalarbeiten (Zeitschrift)

PMU-Autor/inn/en

Pfaff Johannes

Abstract

BACKGROUND AND PURPOSE
Stroke networks have been installed to increase access to advanced stroke specific treatments like mechanical thrombectomy (MT). This concept often requires patients to be transferred to a comprehensive stroke center (CSC) offering MT. Do patient referral, transportation, and logistic effort translate into clinical outcomes comparable to patients admitted primarily to the CSC?
We categorized 112 patients with acute ischemic stroke in the anterior circulation, who received MT at our institution, into primary admissions (A) and referrals from either local (B) or regional (C) hospitals, assessed the clinical outcome, and tested the impact of distance and delay of transportation from the referring remote hospital.
The median time from symptom onset to initial CT was similar in all groups (p = 0,939). Patients who were transferred to the CSC had significantly increasing median time between initial CT and MT (in minutes (interquartile range [IQR]); A: 83 [68-120]; B: 174 [159-208]; C: 220 [181-235]; p < 0.001) and median time between onset to MT (in minutes [IQR]; A: 178 [150-210]; B: 274 [238-349]; C: 293 [256-329]; p < 0.001). After 90 days of MT there was no significant difference in clinical outcome (modified Rankin Scale ≤ 2) between primary admitted and referred patients (p = 0.502).
Clinical outcome in patients who received MT after transfer from either local or regional remote hospitals was not significantly worse than in patients primarily admitted to the CSC. In the event of an acute ischemic stroke patients living in urban or rural areas should, despite a possible delay, have access to MT.


Useful keywords (using NLM MeSH Indexing)

Aged

Female

Germany/epidemiology

Hospitals, Rural/statistics*

numerical data*

Humans

Male

Mechanical Thrombolysis/statistics*

numerical data*

Patient Admission/statistics*

numerical data*

Prevalence

Primary Health Care/statistics*

numerical data*

Referral and Consultation/statistics*

numerical data*

Risk Factors

Stroke/diagnostic imaging

Stroke/epidemiology*

Stroke/therapy*

Treatment Outcome


Find related publications in this database (Keywords)

Acute ischemic stroke
Mechanical thrombectomy
Patient referral
Clinical outcome
Comprehensive stroke center