2023 Volume 45 Issue 6 Pages 453-459
Stroke occurring while driving may not be uncommon. While some elderly drivers sustaining large vessel occlusion (LVO) and subsequent severe stroke may be brought to emergency departments after causing traffic accident (TA), there were few reports on whether mechanical thrombectomy (MT) can be safely performed in that population. Between 2010 and 2019, we treated two elderly drivers who had caused TA secondary to LVO-induced stroke by MT. While MT established good recanalization within 6 h of TA in both patients, the outcomes had not been favorable: a hemispheric infarction developed in a patient with an MCA occlusion and a large hemorrhage developed in the other patient with an ICA occlusion, creating doubt that their outcomes might have been different if MT had been performed earlier. Their therapeutic timelines were critically analyzed to identify what had been the medical/social activities causing delay. The interval between TA and recanalization was trichotomized: (1) between TA and arrival, (2) between arrival and arterial puncture, and (3) between arterial puncture and recanalization. During (1), securement of an injured driver to a backboard in one and accident investigation by police in the other were found to have consumed extra time. During (2), performing bodily CT and abdominal ultrasound was found to have consumed extra time. Coordinated effort by emergency physicians and strokologists to shorten the door-to-needle-time is warranted to improve the outcomes of drivers sustaining large vessel occlusion and causing traffic accident.
