Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA
Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA
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DOI：
10.1136/jnis.2009.000166
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发表时间：
2009-07-01
影响因子：
4.8
通讯作者：
Gonzalez, R. G.
中科院分区：
文献类型：
--
作者：
Hirsch, J. A.;Yoo, A. J.;Gonzalez, R. G.
背景和目的：缺血性中风是美国致残和死亡的主要原因。静脉注射组织型纤溶酶原激活剂（t-PA）仍未得到充分利用。随着新的动脉内再灌注治疗的发展，有更多的机会来解决更具破坏性的大血管闭塞。我们试图确定接受静脉和动脉内治疗的中风患者的数量，并估计在可预见的未来动脉内病例的潜在数量。方法：我们进行了文献检索，以确定静脉注射t-PA的病例量。我们从使用Merci检索装置的病例数中推断出动脉内卒中治疗的当前病例量。为了估计动脉内卒中病例的潜在数量，我们对在两家领先的卒中中心接受动脉内治疗的卒中患者的百分比进行了表征。我们将这些百分比应用于前100名、前200名和前500名中风中心的中风患者数量。结果：美国静脉t-PA使用率为2.4-3.6%，每年约1.5万- 2.2万例。2006年动脉内治疗的估计病例量为3500-7200例。根据St. Luke's Brain and Stroke Institute和Massachusetts General Hospital的数据，大约5-20%的缺血性卒中患者可以接受动脉内治疗。根据容积推算，美国前500个中风中心的潜在动脉内病例数为每年10 400-41 500例。结论：基于目前动脉内病例的数量，我们的理论模型确定了这种中风治疗的显著增长潜力。
Background and purpose: Ischemic stroke is a major cause of disability and death in the USA. Intravenous tissue plasminogen activator (t-PA) remains underutilized. With the development of newer intra-arterial reperfusion therapies, there is increased opportunity to address the more devastating large-vessel occlusions. We seek to identify the numbers of patients with stroke treated with intravenous and intra-arterial therapies, as well as to estimate the potential number of intra-arterial cases in the foreseeable future.Methods: We performed a literature search to determine case volumes of intravenous t-PA use. We extrapolated the current case volume of intra-arterial stroke therapies from the numbers of cases in which the Merci retrieval device was used. In order to estimate the potential numbers of intra-arterial stroke cases, we characterized the percentage of patients with stroke who received intra-arterial therapy at two leading stroke centers. We applied these percentages to the numbers of patients with stroke seen at the top 100, 200 and 500 stroke centers by volume.Results: The rate of intravenous t-PA use is 2.4-3.6%, resulting in 15 000-22 000 cases/year in the USA. The estimated case volume of intra-arterial therapies is 3500-7200 in 2006. Based on data from St. Luke's Brain and Stroke Institute and Massachusetts General Hospital, approximately 5-20% of patients with ischemic stroke can be treated with intra-arterial therapies. Extrapolating this to the top 500 stroke centers by volume, the potential number of intra-arterial cases in the USA is 10 400-41 500/ year.Conclusion: Based on the current numbers of intra-arterial cases, our theoretical model identifies a potential for significant growth of this stroke therapy.