W. Abou Loukoul , S. Richard , G. Mione , S. Finitsis , A.-L. Derelle , F. Zhu , L. Liao , R. Anxionnat , M. Douarinou , L. Humbertjean , B. Gory
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Therefore, we aimed to compare functional and safety outcomes of LVO patients eligible for MT managed through our regional telestroke system.</p></div><div><h3>Method</h3><p><span>We performed a retrospective analysis of our observational prospective clinical registry in all consecutive subjects with LVO within six hours of onset who were admitted to the SC, PSC, or CSC in the east of France between October 2017 and November 2022. The primary endpoint was the functional independence defined as modified Rankin scale (mRS) score 0 to 2 at 90 days. Secondary endpoints were functional outcome, early neurological improvement, symptomatic </span>intracranial hemorrhage and 90-day mortality.</p></div><div><h3>Results</h3><p><span>Among the 794 included patients with LVO who underwent MT, 122 (15.4%) were managed by a SC, 403 (50.8%) were first admitted to a PSC, and 269 (33.9%) were first admitted to the CSC. The overall median NIHSS<span> and ASPECTS score were 16 and 8, respectively. 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引用次数: 0
摘要
背景和目的:疑似中风的患者被转诊到最近的医院，并在spoke中心(SC)、primary卒中中心(PSC)或comprehensive卒中中心(CSC)进行治疗，以便从早期静脉溶栓(IVT)中获益。在大血管闭塞(LVO)的情况下，机械取栓(MT)仅在CSC中进行，而MT的有效性高度依赖于时间。对于疑似LVO患者的最佳管理模式存在争议。因此，我们的目的是比较通过我们的区域性远程卒中系统进行MT管理的LVO患者的功能和安全性结果。方法:我们对2017年10月至2022年11月在法国东部的SC、PSC或CSC住院的所有连续6小时内LVO患者的观察性前瞻性临床登记进行了回顾性分析。主要终点是功能独立性，定义为90天时修改的Rankin量表(mRS)评分0到2分。次要终点是功能结局、早期神经系统改善、症状性颅内出血和90天死亡率。结果:在794例接受MT治疗的LVO患者中，122例(15.4%)接受SC治疗，403例(50.8%)首次入住PSC, 269例(33.9%)首次入住CSC。NIHSS和ASPECTS的总中位数分别为16分和8分。多因素分析未发现PSC与CSC患者的主要终点有显著差异(OR 1.06 [95% CI 0.64;1.76]， P=0.82)， SC与CSC患者的主要终点有显著差异(OR 0.69 [0.34;1.40]， P=0.30)。除了PSC和CSC的实质血肿率(15.7 vs 7.4%， OR 2.25 [1.07;4.74]， P=0.032)外，三组间无差异。结论:与首次入住CSC相比，首次入住SC或PSC的符合MT条件的LVO卒中患者的临床结果相似。
Outcome of stroke patients eligible to mechanical thrombectomy managed by spoke center, primary stroke center or comprehensive stroke center in the East of France
Background and purpose
Patients with suspected stroke are referred to the nearest hospital and are managed either in a spoke center (SC), a primary stroke center (PSC), or a comprehensive stroke center (CSC) in order to benefit from early intravenous thrombolysis (IVT). In case of large vessel occlusion (LVO), mechanical thrombectomy (MT) is only performed in the CSC, whereas the effectiveness of MT is highly time-dependent. There is a debate about the best management model of patients with suspected LVO. Therefore, we aimed to compare functional and safety outcomes of LVO patients eligible for MT managed through our regional telestroke system.
Method
We performed a retrospective analysis of our observational prospective clinical registry in all consecutive subjects with LVO within six hours of onset who were admitted to the SC, PSC, or CSC in the east of France between October 2017 and November 2022. The primary endpoint was the functional independence defined as modified Rankin scale (mRS) score 0 to 2 at 90 days. Secondary endpoints were functional outcome, early neurological improvement, symptomatic intracranial hemorrhage and 90-day mortality.
Results
Among the 794 included patients with LVO who underwent MT, 122 (15.4%) were managed by a SC, 403 (50.8%) were first admitted to a PSC, and 269 (33.9%) were first admitted to the CSC. The overall median NIHSS and ASPECTS score were 16 and 8, respectively. Multivariate analysis did not find any significant difference for the primary endpoint between patients managed by PSC versus CSC (OR 1.06 [95% CI 0.64;1.76], P = 0.82) and between patient managed by SC versus CSC (OR 0.69 [0.34;1.40], P = 0.30). No difference between the three groups was found except for the parenchymal hematoma rate between PSC and CSC (15.7 versus 7.4%, OR 2.25 [1.07;4.74], P = 0.032).
Conclusions
Compared with a first admission to a CSC, the clinical outcomes of stroke patients with LVO eligible for MT first admitted to a SC or a PSC are similar.
期刊介绍：
The first issue of the Revue Neurologique, featuring an original article by Jean-Martin Charcot, was published on February 28th, 1893. Six years later, the French Society of Neurology (SFN) adopted this journal as its official publication in the year of its foundation, 1899.
The Revue Neurologique was published throughout the 20th century without interruption and is indexed in all international databases (including Current Contents, Pubmed, Scopus). Ten annual issues provide original peer-reviewed clinical and research articles, and review articles giving up-to-date insights in all areas of neurology. The Revue Neurologique also publishes guidelines and recommendations.
The Revue Neurologique publishes original articles, brief reports, general reviews, editorials, and letters to the editor as well as correspondence concerning articles previously published in the journal in the correspondence column.
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