부산대학교 도서관

Our institution provides medical support to clinics on the islands of Tokyo using an image transfer system. In cases of emergency examination and treatment, patients are transferred by an air ambulance to our institution. We encountered a case requiring “Drip, Ship, and Retrieve,” wherein an elderly patient had an acute cerebral infarction in Ogasawara, approximately 1000 km away from our institution. The 60-year-old man was air transferred for left hemiparesis and impaired consciousness. An acute cerebral infarction was suspected because head CT showed no intracerebral hemorrhage or early CT ischemic change. Based on patient information and CT image, intravenous thrombolysis therapy was indicated. Intravenous thrombolysis therapy was performed at 2 hours of onset of stroke, and he was transported to our hospital by air. This patient arrived at our institution 12.5 hours from onset of stroke. He was diagnosed with cerebral infarction due to acute internal carotid artery occlusion. The patient underwent endovascular thrombectomy, and reperfusion for thrombolysis in cerebral infarction 2b was established. The modified Rankin Scale score was 5 at 30 days after stroke, but it improved to 4 at 3 months. To the best of our knowledge, this is the first report of treatment with “Drip, Ship, and Retrieve” for acute cerebral infarction in a patient requiring a long-distance transfer. Remote medical support systems and prolongation of the time window for endovascular treatment in cases of acute cerebral infarction can lead to good treatment outcomes, particularly for patients living in remote areas such as islands of Tokyo.