PLoS ONE (Jan 2021)

Current status of a helicopter transportation system on remote islands for patients undergoing mechanical thrombectomy.

  • Takeshi Hiu,
  • Shimpei Morimoto,
  • Ayaka Matsuo,
  • Kei Satoh,
  • Hiroaki Otsuka,
  • Fumiya Kutsuna,
  • Keisuke Ozono,
  • Kosuke Hirayama,
  • Chikaaki Nakamichi,
  • Kazumi Yamasaki,
  • Yuka Ogawa,
  • Eri Shiozaki,
  • Yoichi Morofuji,
  • Ichiro Kawahara,
  • Nobutaka Horie,
  • Yohei Tateishi,
  • Tomonori Ono,
  • Wataru Haraguchi,
  • Tsuyoshi Izumo,
  • Akira Tsujino,
  • Takayuki Matsuo,
  • Keisuke Tsutsumi

DOI
https://doi.org/10.1371/journal.pone.0245082
Journal volume & issue
Vol. 16, no. 1
p. e0245082

Abstract

Read online

BackgroundMechanical thrombectomy (MT) is standard treatment for acute ischemic stroke (AIS) with large-vessel occlusion within 6 h of symptom onset to treatment initiation (OTP). Recent trials have extended the therapeutic time window for MT to within 24 h. However, MT treatment remains low in remote areas. Nagasaki Prefecture, Japan has many inhabited islands with no neurointerventionalists. Our hospital on the mainland is a regional hub for eight island hospitals. We evaluated clinical outcomes of MT for patients with AIS on these islands versus on the mainland.MethodsDuring 2014-2019, we reviewed consecutive patients with AIS who received MT at our hospital. Patients comprised the Islands group and Mainland group. Patient characteristics and clinical outcomes were compared between groups.ResultsWe included 91 patients (Islands group: 15 patients, Mainland group: 76 patients). Seven patients (46.7%) in the Islands group versus 43 (56.6%) in the Mainland group achieved favorable outcomes. Successful recanalization was obtained in 11 patients (73.3%) on the islands and 67 (88.2%) on the mainland. The median OTP time in the Islands was 365 min. In both the Islands and Mainland groups, the OTP time and successful recanalization were associated with functional outcome. The modified Rankin Scale (mRS) score at 90 days ≤2 was obtained in two patients and mRS = 3 in four patients among eight patients with OTP time >6 h.ConclusionsFew patients with AIS on remote islands have received MT. Although patients who underwent MT on the islands had longer OTP, the clinical outcomes were acceptable. OTP time on remote islands must be shortened, as this is related to functional outcome. In some cases with successful recanalization, a favorable outcome can still be obtained even after 6 h. Even if OTP exceeds 6 h, it is desirable to appropriately select patients and actively perform MT.