介入放射医生在急性缺血性卒中干预中的重要角色——来自美国介入放射协会、欧洲心血管及介入放射协会和澳大利亚介入放射协会的联合声明
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摘要
脑卒中是一个全球重大的公共健康问题,取栓治疗为本世纪脑卒中领域最重要的研究进展,而取栓手术必须在严格的时间窗内才能取得良好的结果。这就需要投入非常多的神经介入医师来保证7天全天候的服务,而目前专业的神经介入医师严重不足。介入放射医生本身具有丰富的各种介入器械操作经验,如果再经过简单的神经专业相关培训,完全有能力和神经科医生一起来从事取栓治疗,从而弥补神经介入医生紧缺的现状。为此,美国、欧洲及澳大利亚介入放射协会发布一项关于介入放射医生从事急性脑卒中治疗的联合声明,该声明对人口密度大的我国可能更有指导意义。
引文
[1]Krishnamurthi RV,Feigin VL,Forouzanfar MH,et al.Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010:findings from the Global Burden of Disease Study 2010[J].Lancet Glob Health,2013,1(5):e259-e281.
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[6]Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl JMed,2015,372(11):1009-1018.
[7]Goyal M,Demchuk AM,Menon BK,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].N Engl JMed,2015,372(11):1019-1030.
[8]Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372(24):2296-2306.
[9]Mocco J,Zaidat OO,Kummer RV,et al.Aspiration thrombectomy after intravenous alteplase versus intravenous alteplase alone[J].Stroke,2016,47(9):2331-2338.
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[12]Saver JL,Goyal M,Bonafe A,et al.Stent-retriever thrombectomy after intravenous t-PA vs.t-PA Alone in stroke[J].N Engl J Med,2015,372(24):2285-2295.
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[14]Casaubon LK,Boulanger JM,Blacquiere D,et al.Canadian stroke best practice recommendations:Hyperacute stroke care guidelines,update 2015[J].Int J Stroke,2015,10(6):924-940.
[15]Powers W,Rabinstein A,Ackerson T,et al.American heart association stroke council,2018 guidelines for the early management of patients with acute ischemic stroke:A guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2018,49(3):e46-e110.
[16]Wahlgren N,Moreira T,Michel P,et al.Mechanical thrombectomy in acute ischemic stroke:Consensus statement by ESO-Karolinska Stroke Update 2014/2015,supported by ESO,ESMINT,ESNRand EAN[J].Int J Stroke,2016,11(1):134-147.
[17]White PM,Bhalla A,Dinsmore J,et al.Standards for providing safe acute ischaemic stroke thrombectomy services(September2015)[J].Clin Radiol,2017,72(2):175.e1-175.e9.
[18]National Institute for Health and Care Excellence.Mechanical clot retrieval for treating acute ischemic stroke,2016[EB/OL].[2018-06-20].http://www.nice.org.uk/guidance/ipg548.
[19]Chia NH,Leyden JM,Newbury J,et al.Determining the number of ischemic strokes potentially eligible for endovascular thrombectomy[J].Stroke,2016,47(5):1377-1380.
[20]Rai AT,Seldon AE,Boo S,et al.A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA[J].J Neurointerv Surg,2017,9(8):722-726.
[21]Smith EE,Saver JL,Cox M,et al.Increase in endovascular therapy in Get With The Guidelines-Stroke after the publication of pivotal trials[J].Circulation,2017,136(24):2303-2310.
[22]Rai AT,Domico JR,Buseman C,et al.A population-based incidence of M2 strokes indicates potential expansion of large vessel occlusions amenable to endovascular therapy[J].J Neurointerv Surg,2018,10(6):510-515.
[23]The Joint Commission.Certification data download,2018[EB/OL].[2018-06-20].https://www.qualitycheck.org/data-download/certification-data-download/.
[24]DNV GL Healthcare.Search Hospitals,2017[EB/OL].[2018-06-20].https://www.dnvglhealthcare.com/hospitals search.
[25]Pérez de la Ossa N,Abilleira S,Dorado L,et al.Access to endovascular treatment in remote areas:Analysis of the reperfusion treatment registry of catalonia[J].Stroke,2016,47(5):1381-1384.
[26]Goyal M,Jadhav AP,Bonafe A,et al.Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke:results from the SWIFT PRIMErandomized controlled trial[J].Radiology,2016,279(3):888-897.
[27]Ng FC,Low E,Andrew E,et al.Deconstruction of interhospital transfer workflow in large vessel occlusion:real-world data in the thrombectomy era[J].Stroke,2017,48(7):1976-1979.
[28]Rinaldo L,Brinjikji W,Mccutcheon BA,et al.Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke[J].J Neurointerv Surg,2017,9(12):1166-1172.
[29]American Heart Association.About the severity-based stroke triage algorithm for EMS,2017[EB/OL].[2018-06-20].https://www.heart.org/idc/groups/ahaecc-public/@wcm/@gwtg/documents/download able/ucm_492024.pdf.
[30]Davis SM,Campbell BC,Donnan GA.Endovascular thrombectomy and stroke physicians[J].Stroke,2017,48(8):2042-2044.
[31]Grotta JC,Lyden P,Brott T.Rethinking training and distribution of vascular neurology interventionists in the era of thrombectomy[J].Stroke,2017,48(8):2313-2317.
[32]Berlis A,Weber W.Interventional Stroke treatment in Germany is a joint effort between Neuro-and General Interventional Radiologists[M].Springer,2016.
[33]Connors JJ 3rd,Sacks D,Black CM,et al.Training guidelines for intra-arterial catheter-directed treatment of acute ischemic stroke:A statement from a special writing group of the Society of Interventional Radiology[J].J Vasc Interv Radiol,2009,20(12):1507-1522.
[34]Lenthall R,Mcconachie N,White P,et al.BSNR training guidance for mechanical thrombectomy[J].Clin Radiol,2017,72(2):175.e11-175.e18.
[35]The Royal College of Radiologists.Supplementary guidance to facilitatethe training of interventional radiology(IR)consultants to undertake stroke thrombectomy[EB/OL].[2018-01-25].https://www.rcr.ac.uk/sites/default/files/mt_i nterim_guidance_document_30-10-2017_final.pdf.
[36]Sacks D,Baxter B,Campbell BCV,et al.Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke:From the American Association of Neurological Surgeons(AANS),American Society of Neuroradiology(ASNR),Cardiovascular and Interventional Radiology Society of Europe(CIRSE),Canadian Interventional Radiology Association(CIRA),Congress of Neurological Surgeons(CNS),European Society of Minimally Invasive Neurological Therapy(ESMINT),European Society of Neuroradiology(ESNR),European Stroke Organization(ESO),Society for Cardiovascular Angiography and Interventions(SCAI),Society of Interventional Radiology(SIR),Society of NeuroInterventional Surgery(SNIS),and World Stroke Organization(WSO)[J].J Vasc Interv Radiol,2018,29(4):441-453.
[37]Alberts MJ,Range J,Spencer W,et al.Availability of endovascular therapies for cerebrovascular disease at primary stroke centers[J].Interv Neuroradiol,2017,23(1):64-68.
[38]Society of Neurointerventional Surgery.About us,2018.Available at http://www.snisonline.org/aboutus.Accessed June 19,2018.
[39]Behzadi GN,Fjetland L,Advani R,et al.Endovascular stroke treatment in a small-volume stroke center[J].Brain Behav,2017,7(4):e00642.
[40]Belisle JG,Mccollom VE,Tytle TL,et al.Intraarterial therapy for acute ischemic strokes[J].J Vasc Interv Radiol,2009,20(3):327-333.
[41]Burkart DJ,Day JS,Henderson K,et al.Efficacy of peripheral interventional radiologists performing endovascular stroke therapy guided by CT perfusion triage of patients[J].J Vasc Interv Radiol,2013,24(9):1267-1272.
[42]Gandini R,Del Giudice C,Chegai F,et al.Encouraging and positive trend towards treatment of acute ischemic stroke performed by vascular interventional radiologist[J].Cardiovasc Intervent Radiol,2014,37(5):1384-1386.
[43]?aňák D,K?cher M,Veverka T,et al.Acute combined revascularization in acute ischemic stroke with intracranial arterial occlusion:self-expanding solitaire stent during intravenous thrombolysis[J].J Vasc Interv Radiol,2013,24(9):1273-1279.
[44]Volny O,Krajina A,Belaskova S,et al.Mechanical thrombectomy performs similarly in real world practice:A 2016 nationwide study from the Czech Republic[J].J Neurointerv Surg,2018,10(8):741-745.
[45]Goyal M,Menon BK,Van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:A meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723-1731.
[2]Benjamin EJ,Virani SS,Callaway CW,et al.Heart disease and stroke statistics-2018 update:a report from the American Heart Association[J].Circulation,2018,137(12):e67-e492.
[3]Albers GW,Marks MP,Kemp S,et al.Thrombectomy for stroke at6 to 16 hours with selection by perfusion imaging[J].N Engl J Med,2018,378(8):708-718.
[4]Berkhemer OA,Fransen PSS,Beumer D,et al.A randomized trial of intraarterial treatment for acute ischemic stroke[J].N Engl J Med,2015,372(1):11-20.
[5]Bracard S,Ducrocq X,Mas JL,et al.Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke(THRACE):a randomised controlled trial[J].Lancet Neurol,2016,15(11):1138-1147.
[6]Campbell BC,Mitchell PJ,Kleinig TJ,et al.Endovascular therapy for ischemic stroke with perfusion-imaging selection[J].N Engl JMed,2015,372(11):1009-1018.
[7]Goyal M,Demchuk AM,Menon BK,et al.Randomized assessment of rapid endovascular treatment of ischemic stroke[J].N Engl JMed,2015,372(11):1019-1030.
[8]Jovin TG,Chamorro A,Cobo E,et al.Thrombectomy within 8hours after symptom onset in ischemic stroke[J].N Engl J Med,2015,372(24):2296-2306.
[9]Mocco J,Zaidat OO,Kummer RV,et al.Aspiration thrombectomy after intravenous alteplase versus intravenous alteplase alone[J].Stroke,2016,47(9):2331-2338.
[10]Muir KW,Ford GA,Messow CM,et al.Endovascular therapy for acute ischaemic stroke:the Pragmatic Ischaemic Stroke Thrombectomy Evaluation(PISTE)randomised,controlled trial[J].J Neurol Neurosurg Psychiatry,2017,88(1):38-44.
[11]Nogueira RG,Jadhav AP,Haussen DC,et al.Thrombectomy 6 to24 hours after stroke with a mismatch between deficit and infarct[J].N Engl J Med,2018,378(1):11-21.
[12]Saver JL,Goyal M,Bonafe A,et al.Stent-retriever thrombectomy after intravenous t-PA vs.t-PA Alone in stroke[J].N Engl J Med,2015,372(24):2285-2295.
[13]Shireman TI,Wang K,Saver JL,et al.Cost-effectiveness of solitaire stent retriever thrombectomy for acute ischemic stroke[J].Stroke,2017,48(2):379-387.
[14]Casaubon LK,Boulanger JM,Blacquiere D,et al.Canadian stroke best practice recommendations:Hyperacute stroke care guidelines,update 2015[J].Int J Stroke,2015,10(6):924-940.
[15]Powers W,Rabinstein A,Ackerson T,et al.American heart association stroke council,2018 guidelines for the early management of patients with acute ischemic stroke:A guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2018,49(3):e46-e110.
[16]Wahlgren N,Moreira T,Michel P,et al.Mechanical thrombectomy in acute ischemic stroke:Consensus statement by ESO-Karolinska Stroke Update 2014/2015,supported by ESO,ESMINT,ESNRand EAN[J].Int J Stroke,2016,11(1):134-147.
[17]White PM,Bhalla A,Dinsmore J,et al.Standards for providing safe acute ischaemic stroke thrombectomy services(September2015)[J].Clin Radiol,2017,72(2):175.e1-175.e9.
[18]National Institute for Health and Care Excellence.Mechanical clot retrieval for treating acute ischemic stroke,2016[EB/OL].[2018-06-20].http://www.nice.org.uk/guidance/ipg548.
[19]Chia NH,Leyden JM,Newbury J,et al.Determining the number of ischemic strokes potentially eligible for endovascular thrombectomy[J].Stroke,2016,47(5):1377-1380.
[20]Rai AT,Seldon AE,Boo S,et al.A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA[J].J Neurointerv Surg,2017,9(8):722-726.
[21]Smith EE,Saver JL,Cox M,et al.Increase in endovascular therapy in Get With The Guidelines-Stroke after the publication of pivotal trials[J].Circulation,2017,136(24):2303-2310.
[22]Rai AT,Domico JR,Buseman C,et al.A population-based incidence of M2 strokes indicates potential expansion of large vessel occlusions amenable to endovascular therapy[J].J Neurointerv Surg,2018,10(6):510-515.
[23]The Joint Commission.Certification data download,2018[EB/OL].[2018-06-20].https://www.qualitycheck.org/data-download/certification-data-download/.
[24]DNV GL Healthcare.Search Hospitals,2017[EB/OL].[2018-06-20].https://www.dnvglhealthcare.com/hospitals search.
[25]Pérez de la Ossa N,Abilleira S,Dorado L,et al.Access to endovascular treatment in remote areas:Analysis of the reperfusion treatment registry of catalonia[J].Stroke,2016,47(5):1381-1384.
[26]Goyal M,Jadhav AP,Bonafe A,et al.Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke:results from the SWIFT PRIMErandomized controlled trial[J].Radiology,2016,279(3):888-897.
[27]Ng FC,Low E,Andrew E,et al.Deconstruction of interhospital transfer workflow in large vessel occlusion:real-world data in the thrombectomy era[J].Stroke,2017,48(7):1976-1979.
[28]Rinaldo L,Brinjikji W,Mccutcheon BA,et al.Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke[J].J Neurointerv Surg,2017,9(12):1166-1172.
[29]American Heart Association.About the severity-based stroke triage algorithm for EMS,2017[EB/OL].[2018-06-20].https://www.heart.org/idc/groups/ahaecc-public/@wcm/@gwtg/documents/download able/ucm_492024.pdf.
[30]Davis SM,Campbell BC,Donnan GA.Endovascular thrombectomy and stroke physicians[J].Stroke,2017,48(8):2042-2044.
[31]Grotta JC,Lyden P,Brott T.Rethinking training and distribution of vascular neurology interventionists in the era of thrombectomy[J].Stroke,2017,48(8):2313-2317.
[32]Berlis A,Weber W.Interventional Stroke treatment in Germany is a joint effort between Neuro-and General Interventional Radiologists[M].Springer,2016.
[33]Connors JJ 3rd,Sacks D,Black CM,et al.Training guidelines for intra-arterial catheter-directed treatment of acute ischemic stroke:A statement from a special writing group of the Society of Interventional Radiology[J].J Vasc Interv Radiol,2009,20(12):1507-1522.
[34]Lenthall R,Mcconachie N,White P,et al.BSNR training guidance for mechanical thrombectomy[J].Clin Radiol,2017,72(2):175.e11-175.e18.
[35]The Royal College of Radiologists.Supplementary guidance to facilitatethe training of interventional radiology(IR)consultants to undertake stroke thrombectomy[EB/OL].[2018-01-25].https://www.rcr.ac.uk/sites/default/files/mt_i nterim_guidance_document_30-10-2017_final.pdf.
[36]Sacks D,Baxter B,Campbell BCV,et al.Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke:From the American Association of Neurological Surgeons(AANS),American Society of Neuroradiology(ASNR),Cardiovascular and Interventional Radiology Society of Europe(CIRSE),Canadian Interventional Radiology Association(CIRA),Congress of Neurological Surgeons(CNS),European Society of Minimally Invasive Neurological Therapy(ESMINT),European Society of Neuroradiology(ESNR),European Stroke Organization(ESO),Society for Cardiovascular Angiography and Interventions(SCAI),Society of Interventional Radiology(SIR),Society of NeuroInterventional Surgery(SNIS),and World Stroke Organization(WSO)[J].J Vasc Interv Radiol,2018,29(4):441-453.
[37]Alberts MJ,Range J,Spencer W,et al.Availability of endovascular therapies for cerebrovascular disease at primary stroke centers[J].Interv Neuroradiol,2017,23(1):64-68.
[38]Society of Neurointerventional Surgery.About us,2018.Available at http://www.snisonline.org/aboutus.Accessed June 19,2018.
[39]Behzadi GN,Fjetland L,Advani R,et al.Endovascular stroke treatment in a small-volume stroke center[J].Brain Behav,2017,7(4):e00642.
[40]Belisle JG,Mccollom VE,Tytle TL,et al.Intraarterial therapy for acute ischemic strokes[J].J Vasc Interv Radiol,2009,20(3):327-333.
[41]Burkart DJ,Day JS,Henderson K,et al.Efficacy of peripheral interventional radiologists performing endovascular stroke therapy guided by CT perfusion triage of patients[J].J Vasc Interv Radiol,2013,24(9):1267-1272.
[42]Gandini R,Del Giudice C,Chegai F,et al.Encouraging and positive trend towards treatment of acute ischemic stroke performed by vascular interventional radiologist[J].Cardiovasc Intervent Radiol,2014,37(5):1384-1386.
[43]?aňák D,K?cher M,Veverka T,et al.Acute combined revascularization in acute ischemic stroke with intracranial arterial occlusion:self-expanding solitaire stent during intravenous thrombolysis[J].J Vasc Interv Radiol,2013,24(9):1273-1279.
[44]Volny O,Krajina A,Belaskova S,et al.Mechanical thrombectomy performs similarly in real world practice:A 2016 nationwide study from the Czech Republic[J].J Neurointerv Surg,2018,10(8):741-745.
[45]Goyal M,Menon BK,Van Zwam WH,et al.Endovascular thrombectomy after large-vessel ischaemic stroke:A meta-analysis of individual patient data from five randomised trials[J].Lancet,2016,387(10029):1723-1731.