Mechanical thrombectomy for ischaemic stroke in the anterior circulation: off-hours effect
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Mechanical thrombectomy for ischaemic stroke in the anterior circulation: off‑hours effect Olfa Kaaouana1,2 · Nicolas Bricout1,3 · Barbara Casolla1,2 · François Caparros1,2 · Lucie Della Schiava1,2 · François Mounier‑Vehier4 · Marco Pasi1,2 · Nelly Dequatre‑Ponchelle1,2 · Jean‑Pierre Pruvo1,3 · Charlotte Cordonnier1,2 · Hilde Hénon1,2 · Didier Leys1,2 Received: 27 April 2020 / Revised: 20 May 2020 / Accepted: 22 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Patients treated at off-hours for acute conditions have increased mortality rates. This effect has been poorly evaluated in patients treated by mechanical thrombectomy (MT). Objective This study aimed at comparing outcomes between patients treated at off-hours and at working hours by MT for acute stroke due to large-vessel occlusion in the anterior circulation, in a well-organised network. Method We included consecutive adults who underwent MT for large-vessel occlusion in the anterior circulation over a 51-month period, in the network of 16 hospitals from the North-of-France area, sharing similar protocols. Patients underwent magnetic resonance imaging-scans at admission and then 22–36 h later. We compared 3-month outcomes of patients treated at off-hours and at working time, the primary outcome being a modified Rankin scale (mRS) 0 to 2. Results The study population consisted of 1,179 patients (631 women, 53.5%; mean age 72 years; median baseline National Institutes of Stroke Scale 17; 639 at off-hours, 54.2%; 734 treated with rt-PA, 62.3%; median delay stroke recognition to end of MT 281 min). No patient was lost to follow-up. The outcomes did not differ between the two groups: adjusted odds ratio (adjOR) for mRS 0–2: 0.89; 95% confidence interval (CI) 0.67–1.18; adjOR for mRS 0–1: 0.91; 95% CI 0.68–1.21; adjOR for death 1.12; 95% CI 0.81–1.55). Conclusion Our study did not show worse outcomes in patients treated at off-hours. This result suggests that the off-hours effect reported in other studies can be minimized by a coordinated organisation of stroke care providing similar levels of care at off-hours. Keywords Ischaemic stroke · Cerebral ischaemia · Mechanical thrombectomy · Off-hours · Outcome
Introduction Mechanical thrombectomy (MT), alone or with intravenous (i.v.) recombinant tissue-plasminogen activator (rt-PA) in patients with acute cerebral ischaemia due to large-vessel
* Didier Leys didier.leys@univ‑lille.fr 1
Univ-Lille, INSERM U 1172-1, CHU Lille, Lille, France
2
Department of Neurology (Stroke Unit), Roger Salengro Hospital, 59037 Lille, France
3
Department of Neuroradiology, Roger Salengro Hospital, 59037 Lille, France
4
CH Lens, Department of Neurology (Stroke Unit), CHU Lille, Lille, France
occlusion, increases the proportion of independent survivors at 3 months [1–7]. All hospitals admitting acute strokes should offer the possibility to perform MT on a 24/7 basis on site or after referral to another centre within a reasonable delay [8]. At off-ho
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