http://stroke.ahajournals.org/content/48/12/3295?etoc=
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Abstract
Background and Purpose—Endovascular
recanalization treatment for acute ischemic stroke is a complex,
time-sensitive intervention. Trip-and-treat is an interhospital service
delivery model that has not previously been evaluated in the literature
and consists of a shared mobile interventional stroke team that travels
to primary stroke centers to provide on-site interventional capability.
We compared treatment times between the trip-and-treat model and the
traditional drip-and-ship model.
Methods—We
performed a retrospective analysis on 86 consecutive eligible patients
with acute ischemic stroke secondary to large vessel occlusion who
received endovascular treatment at 4 hospitals in Manhattan. Patients
were divided into 2 cohorts: trip-and-treat (n=39) and drip-and-ship
(n=47). The primary outcome was initial door-to-puncture time, defined
as the time between arrival at any hospital and arterial puncture. We
also recorded and analyzed the times of last known well, IV-tPA
(intravenous tissue-type plasminogen activator) administration,
transfer, and reperfusion.
Results—Mean initial door-to-puncture time was 143 minutes for trip-and-treat and 222 minutes for drip-and-ship (P<0.0001). Although there was a trend in longer puncture-to-recanalization times for trip-and-treat (P=0.0887), initial door-to-recanalization was nonetheless 79 minutes faster for trip-and-treat (P<0.0001).
There was a trend in improved admission-to-discharge change in National
Institutes of Health Stroke Scale for trip-and-treat compared with
drip-and-ship (P=0.0704).
Conclusions—Compared
with drip-and-ship, the trip-and-treat model demonstrated shorter
treatment times for endovascular therapy in our series. The
trip-and-treat model offers a valid alternative to current interhospital
stroke transfers in urban environments.
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