徳島大学病院脳卒中センターに搬送されたrt-PA 静注療法の“Drip and Ship” 症例における検討

Recently,“Drip and Ship”treatment conducted in collaboration of a hospital in remote area and an institution capable of emergency stroke treatment under guidance by a stroke specialist has been reported to be effective. “Drip and Ship” treatment refers to initiating intravenous recombinant tissue-type plasminogen activator（rt-PA）infusion at a remote hospital（Drip）and then transporting patients to an institution capable of multimodality management and endovascular treatment of stroke（Ship）. We report here a case analysis and examinations on treatment methods, prognosis, and some other parameters in １６ patients who were transported to the Stroke Care Unit（SCU）of the Tokushima University Hospital while undergoing“Drip and Ship”treatment between June ２０１３ and November ２０１５. Occluded vessels were recanalized by rt-PA administration in ５／１２patients （４２％）. For ６ cases in which recanalization was not achieved with rt-PA, endovascular treatment was performed, and recanalization was obtained in ３ patients（５０％）. There was a marked improvement（８．４points on average）in NIHSS at the time of discharge compared to that before rt-PA administration. A representative case showed a ２６‐point improvement in NIHSS at the time of discharge compared to the pretreatment value. The advantage of“Drip and Ship”treatment is two-fold : It allows for rt-PA treatment of acute ischemic stroke patients at remote-area institutions incapable of multimodality stroke management, and also makes it possible to add endovascular treatment for rt-PA-irresponsive cases in which recanalization of occluded vessels could not be achieved with rt-PA therapy. The results suggest that the“Drip and Ship”treatment is a safe and effective means to eliminate regional disparities in intravenous rt-PA therapy and can make more contributions to the collaborative stroke care in the Tokushima prefecture in the future.