Introduction In Japan, endovascular treatment for acute ischemic stroke from large vessel occlusion should be performed by neurointerventionists. However, most hospitals in Hokkaido, a Northern island of Japan, that offer treatment for cerebral vascular disease do not have access to a neurointerventionist; the rural areas are especially affected. Thus, Hokkaido University has offered support to institutions without a neurointerventionist, to perform endovascular treatment.
The neurointerventionists stationed in other hospitals drive to retrieve the resultant clot since the acute ischemic stroke from large vessel occlusion. We called this the “drive and retrieve system” method, and launched the effective zone for mobile stroke team (EZO) trial to evaluate the validity and efficacy of this method.
Herein, we report the initial results of the EZO trial.
Methods Nine institutes across our affiliated hospitals within a one-hour drive from Sapporo City took part in this trial.
Three of these 9 institutes that have a full-time neurointerventionist were registered as the source. When an episode of acute ischemic stroke requiring intervention occurred in the other 6 hospitals, the available neurointerventionist provided treatment based on the drive and retrieve method. The neurointerventionists’ schedules was updated and distributed to all participating units twice a week, so that the supported hospitals could immediately make contact when required. We analysis the data of 21 cases in the EZO trial from July 2015 to October 2015.
Results For 19 out of 21 cases (90%), endovascular treatment could be performed endovascular immediately. The median time from door- to- puncture was 18 min (interquartile range [IQR]: 49.25--91.5). The median time from puncture to arrival of the neurointerventionist was also 18 minute (IQR: 3.5--30.5). The recanalization rate (TICI 2 b/3) was 81 %.
Conclusion The drive and retrieve system has the potential to support rural medical institutes that do not have access to a full-time neurointerventionist.
Disclosures T. Osanai: None. K. Houkin: None.
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