How can the time to thrombectomy be reduced?

— The challenge facing our new Stroke Care Center —

Abstract

  Thrombectomy is an established treatment for acute ischemic stroke. Along with advances in the development of medical devices for thrombectomy, the time from onset to reperfusion has now become one of the most important factors influencing good patient prognosis. Following the establishment of a new Stroke Care Center in Nara Medical University on October 2017, we carried out a retrospective study in an attempt to identify ways to shorten the time to thrombectomy. The study included 26 cases (15 males, 11 females) that we experienced in our hospital between October 2016 and September 2017, prior to the opening of the Stroke Care Center. The variables examined in the retrospective study included the visit style, reperfusion time, and patient prognosis. The mean age was 75.7 ±12.2 years (age range: 40‒91 years). The NIHSS score on arrival was 17.7±6.6, and a reperfusion of TICI 2b or better was achieved in 21 patients (81%). The door‒to‒puncture (D2P) time was 121.7±54.9 min, and the puncture‒to‒reperfusion (P2R) time was 44.8±23.5 min. Patients were divided into two groups: a first group (cases 1‒13) and a second group (cases 14～26). We demonstrated a significant shortening of the P2R time (p＝0.005) in the second group, although the D2P time remained unchanged. In other words, with the increase of thrombectomy, shortening of the P2R time was achieved due to technical factors, although the D2P time remained unchanged due to systemic factors. The establishment of the new Stroke Care Center is expected to further strengthen the in‒hospital system and improve the coordination with doctors and co‒medical staff members such as paramedics leading to a shorter D2P time.