Efficacy of ‘drive and retrieve’ as a cooperative method for prompt endovascular treatment for acute ischemic stroke

Abstract

BackgroundOutcomes of endovascular treatment for acute ischemic stroke depend on the time interval from onset to reperfusion. Although the centralized ‘mothership’ method is considered preferable, the required transportation time increases the risk that a patient with a stroke may not receive intravenous or endovascular therapy. In contrast, ‘drive and retrieve’ describes a system wherein doctors from comprehensive stroke centers travel to primary stroke centers and provide endovascular treatment for acute ischemic stroke.ObjectiveTo describe the drive and retrieve system and verify the effects of this new collaboration on outcomes in patients with acute ischemic stroke among facilities.MethodsThis non-randomized, single-arm study retrospectively analyzed patients who met the inclusion criteria for endovascular treatment provided through a drive and retrieve system. Among the 122 patients treated by this system, we analyzed the time of onset to recanalization as the primary outcome. We also analyzed the efficacy of the drive and retrieve system using geographic information system analysis.ResultsThe median time from onset to recanalization was 229 min (IQR 170–307 min, 95% CI 201 to 252 min). The upper limit of the 95% CI for the time from onset to recanalization was shorter than the median times reported in two previous trials. Geographic information system analysis revealed an upward trend in the population coverage rate in each secondary medical area after the drive and retrieve method was introduced.ConclusionThe drive and retrieve method may be an effective form of cooperation between facilities located within 1 hour of a comprehensive stroke center.

Long-Term Clinical Outcome and Prognosis After Thrombectomy in Patients With Concomitant Malignancy

“…This incongruity can be attributed to the fact that the treatment criteria in many of the patients in this study were different from those used in the randomized trial designs. Moreover, our result was similar to the comprehensive results of our previously reported EVT trial (25%), which is considered as real world data (15). However, short-term mortality rate in this report (50%) was higher than that observed in clinical trials (8-21%) as well as our previous report (12%).…”

“…Prestroke mRS score was 0 for nine patients, 2 for one patient, and 3 for two patients. NIHSS score at admission was 17.2 [interquartile range (IQR), [14][15][16][17][18][19][20][21] and ASPECTS ranged from 8 to 10. The location of atrial occlusions was determined at the internal cerebral artery (ICA) (n = 2), proximal portion of the middle cerebral artery (MCA) (M1; n = 8), and middle portion of the MCA (M2; n = 2).…”

“…This study was approved by the institutional review boards of the participating institutes, and all the patients or their families provided written informed consent. A retrospective review of data, between April 2015 and March 2019, using our local stroke database was conducted (15). Concomitant malignancy was defined when the patient was diagnosed in the past 6 months, when the patient was undergoing malignancy treatment, or when the patient showed progression, recurrence, or metastasis of malignancy (4,16).…”

“…Treatment strategies for EVT indication and associated procedures have been previously reported (15). Briefly, National Institutes of Health Stroke Scale (NIHSS) and prestroke modified Rankin Scale (mRS) were used by neurologists upon arrival of the patient at the Emergency Department for neurological assessment.…”

Cost Effectiveness of Drive and Retrieve System in Hokkaido for Acute Ischemic Stroke Patient Treatment Using Geographic Information System

“…where neurointerventionists, who work at comprehensive stroke centers, travel to primary stroke centers to provide endovascular thrombectomy. By implementing the drive and retrieve system, more patients will be eligible for these treatments, and better outcomes can be expected due to earlier treatment initiation [18]. To provide data to achieve equal and efficient treatments of patients with AIS, this study simulates the effect of the drive and retrieve system on accessibility to rt-PA and endovascular thrombectomy, and assesses the cost effectiveness of drive and retrieve system from the perspective of medical and nursing care expenditures.…”