Outcomes and Issues of ‘Drip and Go’ as an Inter-Hospital Cooperation System in Mechanical Thrombectomy for Acute Ischemic Stroke

Abstract

Mechanical thrombectomy in acute ischemic stroke (AIS) has become popular in recent years. Our affiliated institutes without neuro-endovascular specialists call our department to come to assist and perform thrombectomy (Drip and Go). In this study, the effectiveness of this inter-hospital cooperative system was evaluated.Methods: Between January 2016 and December 2018, "Drip and Go" was performed in a total of 29 patients (20 males, average age of 75 years) from four hospitals located within a 1-hour drive, that frequently called for AIS assistance. The background and outcomes of such cases were then retrospectively collected and evaluated. Results:The median National Institutes of Health Stroke Scale (NIHSS) and diffusion-weighed image-Alberta Stroke Programme Early CT Score (DWI-ASPECTS) were 19 and 7, respectively. Gro in puncture was performed in 27 patients (93%) within 6 h of onset. Good reperfusion (thrombolysis in cerebral infarction [TICI] 2b/3) was obtained in 24 patients (82%) with only one patient exhibiting hemorrhagic complication. A total of 12 patients (41%) had a modified Rankin Scale (mRS) score of 0-3 after 90 days or at the time of discharge. Univariate analysis identified a DWI-ASPECTS of 7 or higher as the only significant factor associated with a good neurological prognosis (P <0.05). Neurological prognosis was the most favorable at the furthest hospital where patients had a good DWI-ASPECTS. Conclusion:By employing a 1-hour arrival time window and proper patient selection, the "Drip and Go" inter-hospital cooperative system can be an alternative approach for covering areas where no neuro-endovascular specialists are available for AIS.Keywords▶ acute ischemic stroke, mechanical thrombectomy, inter-hospital cooperation system, drip and go This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives International License.