Effect of referral on intravascular treatment of acute ischemic stroke with large vessel occlusion / 第二军医大学学报

ABSTRACT

Objective To explore the impact of referral on intravascular treatment of acute ischemic stroke patients with large vessel occlusion (AIS-LVO), and to analyze the influence factors of prognosis. Methods We retrospectively analyzed the clinical data of the AIS-LVO patients who received intravascular treatment from Sep. 2013 to Feb. 2018 in Stroke Center of our hospital. The patients were divided into directly admitted group and referral group. The patients in the directly admitted group went directly to the Emergency of our hospital through the pre-hospital emergency medical service or other vehicles. The patients in the referral group were transferred from other hospitals to the Emergency of our hospital. The clinical features, curative effect and prognosis were analyzed between the two groups. Then the patients were divided into good prognosis group (modified Rankin scale score at 90 d after operation being 0-2) and poor prognosis group (2). The clinical data and visit methods were analyzed between the good prognosis and poor prognosis groups, and logistic regression analysis was used to analyze the P0.1 variables. Results A total of 316 patients were included, and the directly admitted group had 195 cases (61.7%) and the referral group had 121 cases (38.3%). Compared with the directly admitted group, the proportions of the patients with ischemic stroke and bridging therapy were significantly lower in the referral group (χ2＝4.549, P＝0.033; χ2＝29.319, P0.001). The onset-to-door time (ODT) and onset-to-recanalization time (ORT) were significantly longer in the referral group than those in the directly admitted group (239 [168, 238] min vs 85 [55, 170] min, Z＝1.779, P0.001; 397 [306, 472] min vs 285 [214, 364] min, Z＝6.779, P0.001). The short-term treatment efficiency and good prognosis rate were significantly worse in the referral group than those in the directly admitted group (52.9% [64/121] vs 64.1% [125/195], χ2＝3.903, P＝0.048; 46.3% [56/121] vs 57.9% [113/195], χ2＝4.806, P＝0.043). There were 169 cases (53.5%) in the good prognosis group and 147 cases (46.5%) in the poor prognosis group. Compared with the poor prognosis group, the patients were significantly younger, the proportion of the patients with hyperlipidemia was significantly lower and the proportion of the patients with bridging therapy was significantly higher in the good prognosis group ([64.2±12.8] years vs [69.9±11.9] years, t＝4.095, P0.001; 0.6% [1/169] vs 6.1% [9/147], χ2＝7.848, P＝0.005; 70.4% [119/169] vs 13.6% [20/147], χ2＝102.975, P0.001). Compared with the poor prognosis group, the proportion of directly admitted patients was significantly higher in the good prognosis (66.9% [113/169] vs 55.8% [82/147], χ2＝4.086, P＝0.043), and ODT and ORT were significantly shorter in the good prognosis group (106 [59, 214] min vs 184 [91, 281] min, Z＝3.997, P0.001; 308 [226, 389] min vs 350 [267, 453] min, Z＝2.999, P＝0.003). Logistic regression analysis showed that bridging therapy, direct visit and short ODT were independent predictors of good prognosis in AIS-LVO patients with intravascular treatment. Conclusion The prognosis of referral AIS-LVO patients with intravascular treatment is poorer compared with the directly admitted patients. Bridging therapy, direct visit and short ODT indicate good prognosis in AIS-LVO patients.