Research Article| Volume 29, ISSUE 6, 104752, June 2020

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Tokyo Metropolitan Stroke Emergency Medical Services for Interventional Stroke Treatment: The Tama-REgistry of Acute Thrombectomy (TREAT) Study



      It is not clear how patients with large vessel occlusion (LVO) who have undergone mechanical thrombectomy (MT) were transported to hospitals by emergency medical services. Here, we describe the current status of the stroke delivery system in a large city.


      We investigated data from 328 patients (male, n = 199; average age, 74.8 ± 12.9 years) who underwent MT at 12 facilities in the Tama area of Tokyo, between January 2015 and December 2017. The patients were classified according to the destination institution as Stroke A eligible (group A, n = 266 [8.2%]), Tertiary critical care center (group T; n = 35 [10.7%]), and other destinations such as emergency rooms (group O; n = 27 [8.2%]), and then reasons for using Emergency Medical Service (EMS) services and outcomes were compared among the groups.


      Rates of milder stroke, and middle cerebral artery occlusion were significantly higher in group A than T, whereas that of vertebral-basilar artery occlusion was significantly lower in group A than in groups T and O. The amount of elapsed time from door to picture (DTP) was significantly lower in group A. The time from onset to recanalization, as well as rates of successful recanalization and favorable outcomes (90-day modified Rankin scale 0-2) did not significantly differ regardless of destination.


      Most patients with LVO in the Tama area were categorized into group A. DTP was significantly lower in group A.

      Key Words


      CPSS (Cincinnati Prehospital Stroke Scale Score), DTP (Door to picture), DTR (Door to recanalization), LVO (Large vessel occlusion), MT (Mechanical thrombectomy), mTICI (Modified thrombolysis in cerebral infarction), OTD (Onset to door), OTR (Onset to recanalization), pc-ASPECTS (Posterior circulation Alberta Stroke Program Early CT Score), PTP (Picture to puncture), PTR (Puncture to recanalization), t-PA (Tissue plasminogen activator, Tama Registry of Acute Thrombectomy)
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