Characteristics of the Drip-and-Ship Paradigm for Patients with Acute Ischemic Stroke in South Korea

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• 作者：Man-Seok Park ; MD^* ; Ji Sung Lee ; PhD^&dagger ; ; Tai Hwan Park ; MD^&Dagger ; ; Yong-Jin Cho ; MD^§ ; ; Keun-Sik Hong ; MD^§ ; ; Jong-Moo Park ; MD^‖ ; Kyusik Kang ; MD^‖ ; Kyung Bok Lee ; MD^¶ ; ; Jae Guk Kim ; MD^# ; Soo Joo Lee ; MD^# ; Jun Lee ; MD^** ; Kang-Ho Choi ; MD^* ; Joon-Tae Kim ; MD^* ; Ki-Hyun Cho ; MD^* ; Mi Sun Oh ; MD^&dagger ; &dagger ; ; Kyung-Ho Yu ; MD^&dagger ; &dagger ; ; Byung-Chul Lee ; MD^&dagger ; &dagger ; ; Jae-Kwan Cha ; MD^&Dagger ; &Dagger ; ; Dae-Hyun Kim ; MD^&Dagger ; &Dagger ; ; Hyun-Wook Nah ; MD^&Dagger ; &Dagger ; ; Juneyoung Lee ; PhD^§ ; § ; ; Dong-Eog Kim ; MD^‖‖ ; Wi-Sun Ryu ; MD^‖‖ ; Beom Joon Kim ; MD^¶ ; ¶ ; ; Moon-Ku Han ; MD^¶ ; ¶ ; ; Hee-Joon Bae ; MD^¶ ; ¶ ; ; Sook-Keun Song ; MD^## ; Jay Chol Choi ; MD^## ; ^{jaychoi@jejunu.ac.kr" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Acute ischemic stroke ; endovascular treatment ; drip-and-ship ; outcome assessment
• 刊名：Journal of Stroke and Cerebrovascular Diseases
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：25
• 期：11
• 页码：2678-2687
• 全文大小：827 K

文摘

Data on the drip-and-ship paradigm in Korea are limited. The present study aimed to evaluate the use of the drip-and-ship paradigm and the time delays and outcomes associated with the paradigm in Korea.

Methods

We used data from the Clinical Research Center for Stroke-5 registry between January 2011 and March 2014. Among patients treated with tissue-type plasminogen activator (tPA), the use of the drip-and-ship paradigm was evaluated, and time delays and functional outcomes at 3 months were compared between patients treated with the paradigm and those treated directly at visits.

Results

Among 1843 patients who met the eligibility criteria, 244 patients (13.2%) were treated with the drip-and-ship paradigm. Subsequent endovascular recanalization therapy was used in 509 patients (27.6%). The median time from symptom onset to groin puncture was greater in patients treated with the paradigm than in those treated directly at visits (305 versus 200 minutes, P < .001). In multivariate analysis, the risks of unfavorable functional outcomes and symptomatic intracranial hemorrhage were higher inpatients treated with the paradigm than in those directly treated at visits (odds ratio [OR] 2.15; 95% confidence interval [CI], 1.50-3.08; P < .001 and OR 1.78; 95% CI, 1.02-3.12; P = .041, respectively).

Conclusions

In Korea, the drip-and-ship paradigm was used in less than 15% of all patients treated with tPA. The use of the paradigm might cause an increase in the onset-to-groin puncture time. Additionally, clinical outcomes might be worse in patients treated with the paradigm than in those treated directly at visits.