Widening Time Disparities between Two Paradigms: Tama-REgistry of Acute Endovascular Thrombectomy

Keigo Shigeta; Takahiro Ota; Tatsuo Amano; Masayuki Ueda; Yuji Matsumaru; Yoshiaki Shiokawa; Teruyuki Hirano

doi:10.1016/j.jstrokecerebrovasdis.2019.01.021

Widening Time Disparities between Two Paradigms: Tama-REgistry of Acute Endovascular Thrombectomy

J Stroke Cerebrovasc Dis. 2019 May;28(5):1267-1273. doi: 10.1016/j.jstrokecerebrovasdis.2019.01.021. Epub 2019 Feb 13.

Authors

Keigo Shigeta¹, Takahiro Ota², Tatsuo Amano³, Masayuki Ueda⁴, Yuji Matsumaru⁵, Yoshiaki Shiokawa⁶, Teruyuki Hirano⁷

Affiliations

¹ Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
² Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
³ Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan.
⁴ Department of Neurology and Stroke Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
⁵ Division of Stroke Prevention and Treatment, Department of Neurosurgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
⁶ Department of Neurosurgery, Kyorin University, Tokyo, Japan.
⁷ Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan. Electronic address: terry@ks.kyorin-u.ac.jp.

PMID: 30772163
DOI: 10.1016/j.jstrokecerebrovasdis.2019.01.021

Abstract

Background: The Tama-REgistry of Acute endovascular Thrombectomy (TREAT) is a multicenter registry of endovascular thrombectomy in the Tama area of Tokyo. The objective of this study was to confirm the real-world status of 2 paradigms of transportation.

Methods: This was a retrospective analysis of data from TREAT. Patients were divided into 2 groups and 2 periods: directly admitted to an endovascular thrombectomy-capable center (ECC; group D)/secondary transfer from a non-ECC (group S), and the first period/the second period. Transfer distance, workflow metrics, and clinical outcomes were analyzed.

Results: A total of 326 patients, including 264 in group D and 62 in group S, were analyzed. The median distance from the onset-to-ECC was 3.62km for group D and 7.87km for group S (P < .001). The median onset-to-needle (OTN) time was longer for group S (168 minutes) than group D (138 minutes; P = .006). The median onset-to-reperfusion (OTR) time was significantly shorter for group D (247 minutes) than for group S (304 minutes; P = .029). With respect to the 2 periods, there was no significant difference in onset-to-puncture time between the 2 groups in the first period (207 minutes versus 243.5 minutes, respectively, P = .50), while there was one in the second period (164 minutes versus 246.5 minutes, respectively, P = .02).

Conclusions: This region-wide registry study showed longer OTN and OTR times, with no improvement of the time course over time in patients transported via non-ECCs. These results should be used to create a regional medical policy for the management of acute ischemic stroke.

Keywords: Emergent large vessel occlusion; acute ischemic stroke; mechanical thrombectomy; stroke bypass; transportation.

Publication types

Comparative Study
Multicenter Study

MeSH terms

Aged
Aged, 80 and over
Endovascular Procedures*
Female
Healthcare Disparities*
Humans
Male
Middle Aged
Process Assessment, Health Care*
Registries
Retrospective Studies
Stroke / diagnosis
Stroke / surgery*
Thrombectomy / methods*
Time Factors
Time-to-Treatment*
Tokyo
Transportation of Patients / methods*
Treatment Outcome