Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke
Background With recent trials demonstrating benefit of endovascular thrombectomy (EVT) up to 24 hours from last known well time (LKWT), emergency medical services systems must consider stroke center routing for patients with LKWT ≤24 hours. We sought to determine the frequency of thrombectomy by pre...
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| Format: | Article |
| Language: | English |
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Wiley
2023-03-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.122.000519 |
| _version_ | 1797346860542722048 |
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| author | Nichole Bosson Jeffrey L. Saver Patrick D. Lyden Marianne Gausche‐Hill |
| author_facet | Nichole Bosson Jeffrey L. Saver Patrick D. Lyden Marianne Gausche‐Hill |
| author_sort | Nichole Bosson |
| collection | DOAJ |
| description | Background With recent trials demonstrating benefit of endovascular thrombectomy (EVT) up to 24 hours from last known well time (LKWT), emergency medical services systems must consider stroke center routing for patients with LKWT ≤24 hours. We sought to determine the frequency of thrombectomy by prehospital‐determined LKWT using retrospective data from a tiered regional stroke care system. Methods During the July 2018 to March 2019 study period, patients with potential large‐vessel occlusion, based on a Los Angeles Motor Scale of 4 or 5, were routed directly to a designated EVT center if within 30 minutes. We determined the frequency of thrombectomy by time intervals from prehospital‐determined LKWT to first medical contact. Results Emergency medical services transported 830 patients with acute ischemic stroke with documented prehospital‐determined LKWT ≤24 hours to EVT centers. The ≤6 hours, >6 to ≤16 hours, and >16 to ≤24 hours epochs accounted for 75%, 20%, and 5% of transports to EVT centers, respectively. Men accounted for 47% of the study population, with a median age of 77 years (interquartile range, 64–86 years) and National Institutes of Health Stroke Scale median of 11 (interquartile range, 4–20). Overall, 28.2% (234/830) received EVT. Time window–specific EVT frequencies were: ≤6 hours (29.8% of patients [187/627]); >6 to ≤16 hours (24.1% of patients [39/162]); and >16 to ≤24 hours (19.5% of [8/41]). Conclusion In this regional stroke system with 2‐tiered routing, patients in the >6‐ to 24‐hour postonset window accounted for nearly one fourth of transports to EVT centers and 23% received thrombectomy. |
| first_indexed | 2024-03-08T11:39:19Z |
| format | Article |
| id | doaj.art-51255b765daa41de934f9757bfc7de37 |
| institution | Directory Open Access Journal |
| issn | 2694-5746 |
| language | English |
| last_indexed | 2024-03-08T11:39:19Z |
| publishDate | 2023-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj.art-51255b765daa41de934f9757bfc7de372024-01-25T09:28:48ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-03-013210.1161/SVIN.122.000519Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic StrokeNichole Bosson0Jeffrey L. Saver1Patrick D. Lyden2Marianne Gausche‐Hill3Harbor‐UCLA Medical Center Torrance Torrance CARonald Reagan UCLA Medical Center Los Angeles CAZilkha Neurogenetic Institute of the Keck University School of Medicine at USC Los Angeles CAHarbor‐UCLA Medical Center Torrance Torrance CABackground With recent trials demonstrating benefit of endovascular thrombectomy (EVT) up to 24 hours from last known well time (LKWT), emergency medical services systems must consider stroke center routing for patients with LKWT ≤24 hours. We sought to determine the frequency of thrombectomy by prehospital‐determined LKWT using retrospective data from a tiered regional stroke care system. Methods During the July 2018 to March 2019 study period, patients with potential large‐vessel occlusion, based on a Los Angeles Motor Scale of 4 or 5, were routed directly to a designated EVT center if within 30 minutes. We determined the frequency of thrombectomy by time intervals from prehospital‐determined LKWT to first medical contact. Results Emergency medical services transported 830 patients with acute ischemic stroke with documented prehospital‐determined LKWT ≤24 hours to EVT centers. The ≤6 hours, >6 to ≤16 hours, and >16 to ≤24 hours epochs accounted for 75%, 20%, and 5% of transports to EVT centers, respectively. Men accounted for 47% of the study population, with a median age of 77 years (interquartile range, 64–86 years) and National Institutes of Health Stroke Scale median of 11 (interquartile range, 4–20). Overall, 28.2% (234/830) received EVT. Time window–specific EVT frequencies were: ≤6 hours (29.8% of patients [187/627]); >6 to ≤16 hours (24.1% of patients [39/162]); and >16 to ≤24 hours (19.5% of [8/41]). Conclusion In this regional stroke system with 2‐tiered routing, patients in the >6‐ to 24‐hour postonset window accounted for nearly one fourth of transports to EVT centers and 23% received thrombectomy.https://www.ahajournals.org/doi/10.1161/SVIN.122.000519emergency medical servicesischemic strokethrombectomy |
| spellingShingle | Nichole Bosson Jeffrey L. Saver Patrick D. Lyden Marianne Gausche‐Hill Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke Stroke: Vascular and Interventional Neurology emergency medical services ischemic stroke thrombectomy |
| title | Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke |
| title_full | Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke |
| title_fullStr | Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke |
| title_full_unstemmed | Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke |
| title_short | Frequency of Thrombectomy in Early and Late Postonset Time Windows Among Emergency Medical Services Patients With Acute Ischemic Stroke |
| title_sort | frequency of thrombectomy in early and late postonset time windows among emergency medical services patients with acute ischemic stroke |
| topic | emergency medical services ischemic stroke thrombectomy |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.122.000519 |
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