‘Drip, Call, and Retrieve’ Paradigm Outcomes in Patients with Acute Ischemic Stroke

Abstract

The procedural time to recanalization is becoming a determining factor in managing acute main-trunk artery occlusion (MAO). Here we report our experience with 27 patients treated with endovascular techniques for MAO without the availability of full-time endovascular specialists. Between July 2012 and March 2014, we targeted 27 patients with acute MAO who received endovascular treatment. Of them, three were transferred to treatment support institutions for treatment (Drip, Ship), while for the remaining 24 patients, an endovascular specialist was called in from an outside medical facility (Drip, Call, and Retrieve). The three patients treated by the Drip, Ship paradigm included two men and one woman with a mean age of 77 (range, 64-85) years. The cerebral infarction was caused by cardiogenic embolism in two patients and by arteriosclerotic embolism in one patient. The mean time interval from the magnetic resonance imaging at our institution to arrival at a treatment support institution was 184 (range, 153-244) minutes, and the mean interval from onset to recanalization was 434 (range, 395-455) minutes. The 24 patients treated with the Drip, Call, and Retrieve paradigm included 11 men and 13 women with a mean age of 77 (range, 62-89) years. Fourteen were administered tissue plasminogen activator, and 21 had arterial fibrillation. The median National Institute of Health Stroke Scale was 15, and the median Alberta Stroke Program Early Computed Tomography Score on diffusion-weighted imaging was 8. Occlusion was observed in 5, 13, 5, and 1 case occurring at the internal carotid artery, middle cerebral artery (M1), M2, and proximal basilar artery. The mean door to puncture time was 117 (range, 39-345) minutes, while the mean time interval from onset to recanalization was 319 (range, 175-555) minutes. A Thrombolysis in Cerebral Infarction (TICI) score ≥2a was achieved in 21 cases (87.5%), while a TICI ≥2b was achieved in 15 (62.5%). The modified Rankin scores at 3 months after treatment were 0-2 in five cases. The Drip, Call, and Retrieve protocol does not require patient transport and is an effective form of medical collaboration that can achieve earlier treatment initiation and serve as an effective educational system for endovascular specialists.