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

doi:10.3877/cma.j.issn.2095-5782.2021.02.007

Abstract

Abstract:

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 thetwo 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(χ² = 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 (χ² = 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.

Key words: Acute ischemic stroke, Stroke center, Transport strategy, Endovascular treatment, Outcome

Yu Hang, Zhenyu Jia, Yuezhou Cao, Linbo Zhao, Huang Huang, Liqin Luan, Haibin Shi, Sheng Liu. Efficiency and efficacy of "drip-and-ship" and "trip-and-treat" on endovascular treatment of acute ischemic stroke with large vessel occlusion[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2021, 09(02): 155-159.

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References 21

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组别		分级转运（n = 63）	会诊治疗（n = 63）	检验值	P值
年龄（岁）		68.8 ± 12.8	63.9 ± 13.2	1.760	0.082
性别（男/女）		27/36	15/18	0.059	0.807
危险因素
	高血压（%）	36（57.1%）	24（72.7%）	2.244	0.134
	糖尿病（%）	12（19.0%）	8（24.2%）	0.354	0.552
	房颤（%）	32（51.0%）	9（27.2%）	4.897	< 0.05
	冠心病（%）	13（20.6%）	8（24.2%）	0.165	0.685
术前NIHSS评分		17.7 ± 8.0	18.8 ± 8.8	-0.602	0.549
发病至就诊时间(min)		68.2 ± 65.0	173.9 ± 169.6	-3.452	< 0.05
静脉溶栓比例（%）		25（39.7%）	18（54.5%）	1.935	0.164
院间距离（km）		43.8 ± 35.3	33.5 ± 26.5	1.616	0.110

组别		分级转运（n = 63）	会诊治疗（n = 63）	检验值	P值
年龄（岁）		68.8 ± 12.8	63.9 ± 13.2	1.760	0.082
性别（男/女）		27/36	15/18	0.059	0.807
危险因素
	高血压（%）	36（57.1%）	24（72.7%）	2.244	0.134
	糖尿病（%）	12（19.0%）	8（24.2%）	0.354	0.552
	房颤（%）	32（51.0%）	9（27.2%）	4.897	< 0.05
	冠心病（%）	13（20.6%）	8（24.2%）	0.165	0.685
术前NIHSS评分		17.7 ± 8.0	18.8 ± 8.8	-0.602	0.549
发病至就诊时间(min)		68.2 ± 65.0	173.9 ± 169.6	-3.452	< 0.05
静脉溶栓比例（%）		25（39.7%）	18（54.5%）	1.935	0.164
院间距离（km）		43.8 ± 35.3	33.5 ± 26.5	1.616	0.110

项目		分级转运（n = 63）	会诊治疗（n = 33）	检验值	P值
闭塞部位				1.460	0.523
	颈内动脉（%）	19（30.2%）	13（39.4%）
	大脑中动脉M1段（%）	40（63.5%）	17（51.5%）
	颈内动脉+大脑中动脉M1段（%）	4（6.3%）	3（9.1%）
TOAST分型				19.651	< 0.05
	大动脉粥样硬化（%）	21（33.3%）	24（72.7%）
	心源性栓塞（%）	42（66.7%）	7（21.2%）
	其他已知的病因（%）	0（0%）	2（6.1%）
	不明原因（%）	0（0%）	0（0%）

项目		分级转运（n = 63）	会诊治疗（n = 33）	检验值	P值
闭塞部位				1.460	0.523
	颈内动脉（%）	19（30.2%）	13（39.4%）
	大脑中动脉M1段（%）	40（63.5%）	17（51.5%）
	颈内动脉+大脑中动脉M1段（%）	4（6.3%）	3（9.1%）
TOAST分型				19.651	< 0.05
	大动脉粥样硬化（%）	21（33.3%）	24（72.7%）
	心源性栓塞（%）	42（66.7%）	7（21.2%）
	其他已知的病因（%）	0（0%）	2（6.1%）
	不明原因（%）	0（0%）	0（0%）

项目	分级转运（n = 63）	会诊治疗（n = 33）	检验值	P值
就诊至血管再通时间（min）	310.7 ± 80.6	247.3 ± 67.7	0.458	< 0.05
股动脉穿刺至血管再通时间（min）	77.7 ± 45.2	119.9 ± 67.0	-3.256	< 0.05
成功再灌注（mTICI 2b/3）（%）	57（90.5%）	29（87.9%）	0.157	0.732
症状性颅内出血（%）	13（20.6）	3（9.1%）	2.078	0.149
90 d良好预后率（mRS 0~2）（%）	30（47.6%）	22（66.7%）	3.165	0.075
90 d死亡率（%）	12（19.0%）	2（6.1%）	2.932	0.087

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