Drip and ship: Una práctica usual en el tratamiento de ictus isquémico por oclusión de arterias proximales en países de altos ingresos pero anecdótica en Colombia. Drip and ship: a prevalent practice in acute stroke with large vessel occlusion in high-income countries but anecdotal in Colombia

Autor: Pablo Amaya, Akemi Arango, Carlos Pardo, Natalia Llanos-Leyton, Edgar Folleco, Hernán Mauricio Patiño-Rodríguez, Ángel Basilio Corredor-Quintero

Rev. Ecuat. Neurol. VOL 30 Nº3, 2021

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Resumen

El Drip and Ship consiste en administrar trombolisis endovenosa en centro primario y remisión para trombectomía mecánica.

Objetivo: Describir la experiencia Drip and Ship como intervención del ictus isquémico en dos regiones de Colombia.

Métodos: Serie de casos retrospectiva de pacientes tratados con Drip and Ship durante 2019 y primer cuartil de 2021. Se compararon variables como puerta-imagen, puerta-aguja, puerta-ingle y desenlaces clínicos. Se calcularon medidas de tendencia central y estadísticas descriptivas.

Resultados: Se registraron seis pacientes con ictus isquémico y oclusión proximal. Mediana de 60 minutos de inicio de síntomas, puerta-aguja 75 minutos, tiempo door-in door-out 167.5 minutos, tiempo de traslado 91.5 minutos para remisión desde otra ciudad. Cinco pacientes recibieron trombectomía mecánica con TICI 2c-3. 50% de los pacientes con Rankin modificado favorable al egreso y 84% a tres meses.

Conclusiones: En el registro RES-Q entre 2019 y el primer cuartil de 2021, se consignaron 5954 casos de ictus isquémico en Colombia, 20 pacientes tratados con Drip and Ship (0,33%). Los tiempos de puerta- aguja y de remisión fueron mayores a lo recomendado en guías internacionales, siendo mayor en los pacientes provenientes de otras ciudades. Se requiere estructurar redes de atención para mejorar tiempos de tratamiento y número de pacientes tratados.

Palabras clave: Ictus isquémico, país de medianos ingresos, trombectomía, Trombolisis,

Summary

The Drip and Ship consists of giving intravenous thrombolysis in the primary center and referral for mechanical thrombectomy.

Objective: To describe the experience of Drip and Ship in acute ischemic stroke in two regions of Colombia.

Methods: We conducted a retrospective case series study of patients undergoing Drip and Ship from 2019 to first quartile of 2021. We compared times: door-to-image, door-to-needle, door-to-groin and clinical outcomes. Measures of central tendency and descriptive statistics were calculated.

Results: Six patients with ischemic stroke and large vessel occlusion were registered. Median of 60 minutes of the onset of symptoms, 75 minutes for door-to-needle, 167.5 minutes for door-in door-out time, and 91.5 minutes for travel time referred from another city. Five patients received mechanical thrombectomy with TICI 2c-3. 50% of patients with favorable modified Rankin scale at discharge and 84% at three months.

Conclusions: According to the RES-Q registry, between 2019 and the first quartile of 2021, there were 5954 cases of ischemic stroke cases in Colombia, and 20 patients received Drip and Ship strategy (0.33%). In agreement to international guidelines, door-to-needle and remission times were longer than recommended, especially in patients from other cities. It is necessary to structure care networks to improve treatment times and the number of patients treated.

Keywords: ischemic stroke, middle income countries, thrombectomy, Thrombolysis,