Background: We have executed a direct doctor-to-doctor telecommunication system (D2D-Call) to perform intraarterial thrombectomy (IAT) for acute ischemic stroke patients, who first visited at local hospitals. We evaluated whether the D2D-Call was effective to perform successful IAT for acute stroke patients visited first at the local hospitals.
Methods: We analyzed clinical data of 201 consecutive patients (male:female=126:75, mean age±SD, 68.4±12.5 years), who underwent IAT to recanalize occluded intracranial vessels from January, 2011 to May, 2015. The patients were classified by the arrival manners at our center; 1) Direct-Arrival at our center (n=140), 2) transfer after D2D-Call (n=38), and 3) transfer with No-D2D-Call (n=23) from local hospitals. Differences of the time intervals from arrival at our center to IAT start (Arrival-to-Puncture) and from symptom onset to recanalization (Onset-to-Recanalization) were analyzed between the three groups. The recanalization rates and clinical outcome of the three groups were also compared between them.
Results: D2D-Call group showed shorter Arrival-to-Puncture time than the other groups (Direct-Arrival, 107.1±28.1; D2D-Call, 49.6±18.3; No-D2D-Call group, 109.8±28.3 minutes, p<0.001). On Onset-to-Recanalization time analysis, D2D-Call group was late 44 minutes yet, but, faster 90 minutes than No-D2D-Call group (Direct-Arrival, 263.9±120.1; D2D-Call, 307.1±70.7; No-D2D-Call group, 393.6±74.9 minutes, p<0.001). Overall recanalization rate of D2D-Call group (76%) was lower than Direct-arrival (84%), but, higher than Non-D2D-call group (65%, p=0.075). Good clinical outcome (defined as 0-3 of modified Rankin Scale) of D2D-Call group (66%) was similar with Direct-Arrival (68%) at 3 months after IAT, but, significantly higher than Non-D2D-Call group (39%) (p=0.030).
Conclusion: Direct communication between doctors of a stroke center and local hospitals could reduce overall onset-to-recanalization time of IAT by shortening of staying in emergency room, and, ultimately could achieve better clinical outcome after IAT for acute ischemic stroke patients visited first at local hospitals.