Abstract
Objective: Endovascular therapy for acute ischemic stroke (emergency neuroendovascular revascularization; ENER) had been performed in Japan, and endovascular thrombectomy for major artery occlusion is strongly recommended in Japanese Guidelines for the Management of Stroke revised in 2017. We summarized the current status of ENER and regional activities in Kinki region, and discussed a solution for spreading ENER.
Methods: The current status of ENER in each prefecture of Kinki region were evaluated based on data received from the nationwide surveillance, Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan Project (RESCUE-Japan Project). The regional activities in each prefecture were summarized from contents of presentation at the 4th Regional Conference of Japanese Society for Neuroendovascular therapy (JSNET) held on September 2, 2017, at Osaka.
Results: In Kinki region, the annual number of ENER was the largest in Osaka Prefecture, while the number of ENER per population was the largest in Hyogo Prefecture. Board physicians and thrombectomy-capable stroke center concentrated in urban areas, resulting in disparities of the annual number of ENER among each second medical service. In all prefecture, transportation of stroke patients by helicopter emergency medical services has been introduced in clinical practice and regular meeting have been held to strengthen collaboration between centers and ambulance service.
Conclusion: Multi-fold approach, including consolidation of thrombectomy-capable stroke centers in the urban area, close co-operation between nearby second medical service areas, and a combination of transportation by helicopter and remote medical support system, will be necessary to make all local residents receive rapid ENER.
