@article{oai:nagasaki-u.repo.nii.ac.jp:00026294,
 author = {Hiu, Takeshi and Morimoto, Shimpei and Matsuo, Ayaka and Satoh, Kei and Otsuka, Hiroaki and Kutsuna, Fumiya and Ozono, Keisuke and Hirayama, Kosuke and Nakamichi, Chikaaki and Yamasaki, Kazumi and Ogawa, Yuka and Shiozaki, Eri and Morofuji, Yoichi and Kawahara, Ichiro and Horie, Nobutaka and Tateishi, Yohei and Ono, Tomonori and Haraguchi, Wataru and Izumo, Tsuyoshi and Tsujino, Akira and Matsuo, Takayuki and Tsutsumi, Keisuke},
 issue = {1},
 journal = {PLOS ONE},
 month = {Jan},
 note = {Background: Mechanical thrombectomy (MT) is standard treatment for acute ischemic stroke (AIS) with large-vessel occlusion within 6 h of symptom onset to treatment initiation (OTP). Recent trials have extended the therapeutic time window for MT to within 24 h. However, MT treatment remains low in remote areas. Nagasaki Prefecture, Japan has many inhabited islands with no neurointerventionalists. Our hospital on the mainland is a regional hub for eight island hospitals. We evaluated clinical outcomes of MT for patients with AIS on these islands versus on the mainland. Methods: During 2014–2019, we reviewed consecutive patients with AIS who received MT at our hospital. Patients comprised the Islands group and Mainland group. Patient characteristics and clinical outcomes were compared between groups. Results: We included 91 patients (Islands group: 15 patients, Mainland group: 76 patients). Seven patients (46.7%) in the Islands group versus 43 (56.6%) in the Mainland group achieved favorable outcomes. Successful recanalization was obtained in 11 patients (73.3%) on the islands and 67 (88.2%) on the mainland. The median OTP time in the Islands was 365 min. In both the Islands and Mainland groups, the OTP time and successful recanalization were associated with functional outcome. The modified Rankin Scale (mRS) score at 90 days ≤2 was obtained in two patients and mRS = 3 in four patients among eight patients with OTP time >6 h. Conclusions: Few patients with AIS on remote islands have received MT. Although patients who underwent MT on the islands had longer OTP, the clinical outcomes were acceptable. OTP time on remote islands must be shortened, as this is related to functional outcome. In some cases with successful recanalization, a favorable outcome can still be obtained even after 6 h. Even if OTP exceeds 6 h, it is desirable to appropriately select patients and actively perform MT., PLOS ONE, 16(1), e0245082; 2021},
 title = {Current status of a helicopter transportation system on remote islands for patients undergoing mechanical thrombectomy},
 volume = {16},
 year = {2021}
}