A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience

被引：33

作者：

Alonso de Lecinana, M. ^{[1
]}

Fuentes, B. ^{[2
]}

Ximenez-Carrillo, A. ^{[3
]}

Vivancos, J. ^{[3
]}

Masjuan, J. ^{[1
]}

Gil-Nunez, A. ^{[4
]}

Martinez-Sanchez, P. ^{[2
]}

Zapata-Wainberg, G. ^{[3
]}

Cruz-Culebras, A. ^{[1
]}

Garcia-Pastor, A. ^{[4
]}

Diaz-Otero, F. ^{[4
]}

Fandino, E. ^{[1
]}

Frutos, R. ^{[1
]}

Caniego, J. -L. ^{[3
]}

Mendez, J. -C. ^{[1
]}

Fernandez-Prieto, A. ^{[2
]}

Barcena-Ruiz, E. ^{[3
]}

Diez-Tejedor, E. ^{[2
]}

机构：

[1] Univ Alcala, IRYCIS, Hosp Univ Ramon Y Cajal, Madrid, Spain

[2] Univ Autonoma Madrid, Hosp Univ La Paz IdiPAZ, Madrid, Spain

[3] Univ Autonoma Madrid, IIS Princesa, Hosp Univ Princesa, Madrid, Spain

[4] Univ Complutense Madrid, IiSGM, Hosp Univ Gregorio Maranon, Madrid, Spain

来源：

EUROPEAN JOURNAL OF NEUROLOGY | 2016年 / 23卷 / 02期

关键词：

endovascular treatment; ischaemic stroke; organized stroke care; stroke management; CARE; REVASCULARIZATION; THROMBOLYSIS; GUIDELINES; MANAGEMENT; THERAPY; TRIAL;

D O I：

10.1111/ene.12749

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

100204 [神经病学];

摘要：

Background and purposeThe complexity and expense of endovascular treatment (EVT) for acute ischaemic stroke (AIS) can present difficulties in bringing this approach closer to the patients. A collaborative node was implemented involving three stroke centres (SCs) within the Madrid Stroke Network to provide round-the-clock access to EVT for AIS. MethodsA weekly schedule was established to ensure that at least one SC was on-call' to provide EVT for all those with moderate to severe AIS due to large vessel occlusion, >4.5h from symptom onset, or within this time-window but with contraindication to, or failure of, systemic thrombolysis. The time-window for treatment was 8h for anterior circulation stroke and <24h in posterior stroke. Outcomes measured were re-canalization rates, modified Rankin Scale (mRS) score at 3months, mortality and symptomatic intra-cranial haemorrhage (SICH). ResultsOver a 2-year period (2012-2013), 303 candidate patients with AIS were considered for EVT as per protocol, and 196 (65%) received treatment. Reasons for non-treatment were significant improvement (14%), spontaneous re-canalization (26%), clinical worsening (9%) or radiological criteria of established infarction (31%). Re-canalization rate amongst treated patients was 80%. Median delay from symptom onset to re-canalization was 323min (p25; p75 percentiles 255; 430). Mortality was 11%; independence (mRS 0-2) was 58%; SICH was 3%. ConclusionsImplementation of a collaborative network to provide EVT for AIS is feasible and effective. Results are good in terms of re-canalization rates and clinical outcomes. Click to view the accompanying paper in this issue.

引用

页码：297 / 303

页数：7

共 18 条

[1]

Outcomes of a Contemporary Cohort of 536 Consecutive Patients With Acute Ischemic Stroke Treated With Endovascular Therapy [J].

Abilleira, Sonia ;

Cardona, Pere ;

Ribo, Marc ;

Millan, Monica ;

Obach, Victor ;

Roquer, Jaume ;

Canovas, David ;

Marti-Fabregas, Joan ;

Rubio, Francisco ;

Alvarez-Sabin, Jose ;

Davalos, Antoni ;

Chamorro, Angel ;

Angeles de Miquel, Maria ;

Tomasello, Alejandro ;

Castano, Carlos ;

Macho, Juan M. ;

Ribera, Aida ;

Gallofre, Miquel .

STROKE, 2014, 45 (04) :1046-1052

[2]

Guidelines for the treatment of acute ischaemic stroke [J].

Alonso de Lecinana, M. ;

Egido, J. A. ;

Casado, I. ;

Ribo, M. ;

Davalos, A. ;

Masjuan, J. ;

Caniego, J. L. ;

Martinez Vila, E. ;

Diez Tejedor, E. ;

Alvarez-Sabin, J. ;

Arenillas, J. ;

Calleja, S. ;

Castellanos, M. ;

Castillo, J. ;

Diaz-Otero, F. ;

Lopez-Fernandez, J. C. ;

Freijo, M. ;

Gallego, J. ;

Garcia-Pastor, A. ;

Gil-Nunez, A. ;

Gilo, F. ;

Irimia, P. ;

Lago, A. ;

Maestre, J. ;

Marti-Fabregas, J. ;

Martinez-Sanchez, P. ;

Molina, C. ;

Morales, A. ;

Nombela, F. ;

Purroy, F. ;

Rodriguez-Yanez, M. ;

Roquer, J. ;

Rubio, F. ;

Segura, T. ;

Serena, J. ;

Simal, P. ;

Tejada, J. ;

Vivancos, J. .

NEUROLOGIA, 2014, 29 (02) :102-122

[3]

Endovascular treatment in acute ischaemic stroke. A Stroke Care Plan for the Region of Madrid [J].

Alonso de Lecinana, M. ;

Diaz-Guzman, J. ;

Egido, J. A. ;

Garcia Pastor, A. ;

Martinez-Sanchez, P. ;

Vivancos, J. ;

Diez-Tejedor, E. .

NEUROLOGIA, 2013, 28 (07) :425-434

[4]

Relevance of Stroke Code, Stroke Unit and Stroke Networks in Organization of Acute Stroke Care - The Madrid Acute Stroke Care Program [J].

Alonso de Lecinana-Cases, Maria ;

Gil-Nunez, Antonio ;

Diez-Tejedor, Exuperio .

CEREBROVASCULAR DISEASES, 2009, 27 :140-147

[5]

A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[6]

Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[7]

Neurovascular intervention in the acute phase of cerebral infarction [J].

Cruz Culebras, A. ;

Garcia-Pastor, A. ;

Reig, G. ;

Fuentes, B. ;

Simal, P. ;

Mendez-Cendon, J. C. ;

Caniego, J. L. ;

Castro, E. ;

Frutos, R. ;

Gil, A. ;

Vivancos, J. ;

Gil-Nunez, A. ;

Diez-Tejedor, E. ;

Egido, J. A. ;

Alonso de Lecinana, M. ;

Masjuan, J. .

NEUROLOGIA, 2010, 25 (05) :279-286

[8]

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke [J].

Goyal, M. ;

Demchuk, A. M. ;

Menon, B. K. ;

Eesa, M. ;

Rempel, J. L. ;

Thornton, J. ;

Roy, D. ;

Jovin, T. G. ;

Willinsky, R. A. ;

Sapkota, B. L. ;

Dowlatshahi, D. ;

Frei, D. F. ;

Kamal, N. R. ;

Montanera, W. J. ;

Poppe, A. Y. ;

Ryckborst, K. J. ;

Silver, F. L. ;

Shuaib, A. ;

Tampieri, D. ;

Williams, D. ;

Bang, O. Y. ;

Baxter, B. W. ;

Burns, P. A. ;

Choe, H. ;

Heo, J. -H. ;

Holmstedt, C. A. ;

Jankowitz, B. ;

Kelly, M. ;

Linares, G. ;

Mandzia, J. L. ;

Shankar, J. ;

Sohn, S. -I. ;

Swartz, R. H. ;

Barber, P. A. ;

Coutts, S. B. ;

Smith, E. E. ;

Morrish, W. F. ;

Weill, A. ;

Subramaniam, S. ;

Mitha, A. P. ;

Wong, J. H. ;

Lowerison, M. W. ;

Sajobi, T. T. ;

Hill, M. D. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1019-1030

[9]

Evaluation of Interval Times From Onset to Reperfusion in Patients Undergoing Endovascular Therapy in the Interventional Management of Stroke III Trial [J].

Goyal, Mayank ;

Almekhlafi, Mohammed A. ;

Fan, Liqiong ;

Menon, Bijoy K. ;

Demchuk, Andrew M. ;

Yeatts, Sharon D. ;

Hill, Michael D. ;

Tomsick, Thomas ;

Khatri, Pooja ;

Zaidat, Osama O. ;

Jauch, Edward C. ;

Eesa, Muneer ;

Jovin, Tudor G. ;

Broderick, Joseph P. .

CIRCULATION, 2014, 130 (03) :265-U120

[10]

Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke [J].

Higashida, RT ;

Furlan, AJ .

STROKE, 2003, 34 (08) :E109-E137

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