Training Guidelines for Endovascular Stroke Intervention: An International Multi-Society Consensus Document

Lavine, S. D.; Cockroft, Kevin M.; Hoh, Brian L.; Bambakidis, Nicholas C.; Khalessi, Alexander A.; Woo, Hyeon-Jun; Riina, Howard A.; Siddiqui, Adnan H.; Hirsch, Joshua A; Chong, Winston; Rice, Henry E.; Wenderoth, Jason; Mitchell, Peter; Coulthard, Alan; Signh, T.J.; Phatorous, C.; Khangure, Makhan S.; Klurfan, Paula; Iancu, Daniela; Gunnarsson, Þorsteinn; Jansen, Olav; Muto, Mario; Szikora, I; Piérot, Laurent; Brouwer, Patrick A.; Gralla, Jan; Renowden, Shelley; Andersson, Tommy; Fiehler, Jens; Turjman, Francis; White, Phil; Januel, Anne-Christine; Spelle, Laurent; Kulcsár, Zsolt; Chapot, René; Dima, Sofia; Taschner, Christian; Szajner, Maciej; Krajina, Antonı́n; Sakai, Nobuyuki; Matsumaru, Yuji; Yoshimura, Shinichi; Vergara-Díaz, Omar; Lylyk, Pedro; Jayaraman, Mahesh; Patsalides, Athos; Gandhi, Chirag D.; Lee, S.K.; Abruzzo, Todd; Albani, Barbara; Ansari, Sameer A; Arthur, Adam S; Baxter, Blaise; Bulsara, Ketan R.; Chen, M.; Almandoz, Josser E Delgado; Fraser, Justin F.; Heck, Don; Hetts, Steven W.; Hussain, Muhammad Shazam; Klucznik, Richard P.; Leslie-Mawzi, Thabele; Mack, William J.; McTaggart, Ryan; Meyers, Philip M.; Mocco, J; Prestigiacomo, Charles J.; Pride, G. Lee; Rasmussen, Peter A.; Starke, Robert M.; Sunenshine, Peter; Tarr, Robert W.; Frei, Donald; Ribó, Marc; Nogueira, Raul G; Zaidat, Osama O.; Jovin, T; Linfante, Italo; Yavagal, Dileep R.; Liebeskind, David S; Novakovic, Robin; Pongpech, Sirintara; Rodesch, Georges; Söderman, Michael; Brugge, Karel ter; Taylor, Allan; Krings, Timo; Orbach, Darren B.; Biondi, Alessandra; Picard, L; Suh, Dae Chul; Tanaka, Michihiro; Zhang, H.Q.

doi:10.1159/000444945

Cited by 13 publications

(7 citation statements)

References 22 publications

(11 reference statements)

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“…CSCs will require round the clock stroke physicians with expertise in endovascular stroke management, and fully trained neurointerventionalists with qualifications based on current models of certification. 21,22 Too many competing EVT centres will not be cost-effective, will compromise quality and will dilute the expertise of specialists. Universal adoption of a uniform definition of SUs and CSCs together with an appropriate certification process would help to guarantee the achievement of set quality targets throughout Europe.…”

Section: Discussionmentioning

confidence: 99%

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Sousa

Martial

Abilleira

et al. 2018

European Stroke Journal

250

200

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Introduction Acute stroke unit care, intravenous thrombolysis and endovascular treatment significantly improve the outcome for patients with ischaemic stroke, but data on access and delivery throughout Europe are lacking. We assessed best available data on access and delivery of acute stroke unit care, intravenous thrombolysis and endovascular treatment throughout Europe. Methods A survey, drafted by stroke professionals (ESO, ESMINT, EAN) and a patient organisation (SAFE), was sent to national stroke societies and experts in 51 European countries (World Health Organization definition) requesting experts to provide national data on stroke unit, intravenous thrombolysis and endovascular treatment rates. We compared both pooled and individual national data per one million inhabitants and per 1000 annual incident ischaemic strokes with highest country rates. Population estimates were based on United Nations data, stroke incidences on the Global Burden of Disease Report. Results We obtained data from 44 European countries. The estimated mean number of stroke units was 2.9 per million inhabitants (95% CI 2.3–3.6) and 1.5 per 1000 annual incident strokes (95% CI 1.1–1.9), highest country rates were 9.2 and 5.8. Intravenous thrombolysis was provided in 42/44 countries. The estimated mean annual number of intravenous thrombolysis was 142.0 per million inhabitants (95% CI 107.4–176.7) and 72.7 per 1000 annual incident strokes (95% CI 54.2–91.2), highest country rates were 412.2 and 205.5. Endovascular treatment was provided in 40/44 countries. The estimated mean annual number of endovascular treatments was 37.1 per million inhabitants (95% CI 26.7–47.5) and 19.3 per 1000 annual incident strokes (95% CI 13.5–25.1), highest country rates were 111.5 and 55.9. Overall, 7.3% of incident ischaemic stroke patients received intravenous thrombolysis (95% CI 5.4–9.1) and 1.9% received endovascular treatment (95% CI 1.3–2.5), highest country rates were 20.6% and 5.6%. Conclusion We observed major inequalities in acute stroke treatment between and within 44 European countries. Our data will assist decision makers implementing tailored stroke care programmes for reducing stroke-related morbidity and mortality in Europe.

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Section: Discussionmentioning

confidence: 99%

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Sousa

Martial

Abilleira

et al. 2018

European Stroke Journal

250

200

View full text Add to dashboard Cite

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“…Although few studies have investigated stroke teams’ and interventionalists’ training and experience and their effects on outcome, it is likely that they lead to improved reperfusion grades and shorter procedure times. 31…”

Section: Discussionmentioning

confidence: 99%

Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

Compagne

Kappelhof

Hinsenveld

et al. 2022

Stroke

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Background: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes. Methods: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended thrombolysis in cerebral infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days). Results: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P <0.001 and 236 versus 270 minutes; P <0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P <0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07–1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98–1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99–1.30]). Outcomes were consistent in the analysis per chronological quartile. Conclusions: Clinical outcomes after endovascular treatment for acute ischemic stroke in routine clinical practice have improved over the past years, likely resulting from improved workflow times and higher successful reperfusion rates.

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“…However, participants were required to show functional independence prior to the stroke (modified Rankin scale (mRS) score of 0-2; range: 0 (normal)-6 (death)). Exclusion criteria were: a large ischaemic core on imaging (ASPECTS <6 or pc-ASPECTS <6), intracranial haemorrhage (ICH) on imaging, hypertension (systolic blood pressure)>185 mm Hg and/or diastolic blood pressure >110 mm Hg) after treatment with drugs, baseline platelet count <30×10 9 and utilisation of anticoagulants with International Normalised Ratio >3.0.…”

Section: Study Design and Patientsmentioning

confidence: 99%

Comparing a novel Catfish flow restoration device and the Solitaire stent retriever for thrombectomy revascularisation in emergent largevessel occlusion stroke: a prospective randomised controlled study

Luo

Yan

Xiao³

et al. 2023

Stroke Vasc Neurol

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BackgroundThe Catfish stent retriever is a newly developed mechanical thrombectomy device for rapid recanalisation in emergent large vessel occlusion (ELVO) stroke. The current trial aimed to assess whether the Catfish stent retriever is non-inferior to the Solitaire stent retriever in terms of outcomes in ELVO stroke.MethodsThis was a randomised, prospective, parallel-group, multicentre, open-label, non-inferiority study conducted at 18 sites in China. The primary outcome was the proportion of cases with successful recanalisation (modified thrombolysis in cerebral infarction score of 2b or 3) following the procedure. Secondary efficacy outcomes included the National Institutes of Health Stroke Scale scores at 24 hours and 7 days or discharge if earlier, time from artery puncture to successful recanalisation and good clinical outcome (modified Rankin scale score ≤2) at 90 days. Safety outcomes included symptomatic intracranial haemorrhage, all cause-death and severe adverse events at 90 days.ResultsBetween 3 March 2019 and 5 June 2021, 118 and 120 patients were randomly allocated to the Catfish and Solitaire groups, respectively. The primary endpoint after all endovascular procedures was non-inferior in the Catfish group (88.5%, 100/113) than in the Solitaire group (87.7%, 100/114), with a rate difference (RD) of 0.78% (95% CI –7.64 to –9.20; p=0.001). Sensitivity analysis only considering the per-protocol set also yielded similar results, with an RD of 0.83% (95% CI –7.03 to –8.70; p<0.001). Additionally, the proportions of cases with good clinical outcomes (47.8% vs 50.0%, p=0.739) and all-cause death rates (17.7% vs 18.8%, p=0.700) were similar in both groups at 90 days.ConclusionsThe Catfish stent retriever is an effective and safe device for endovascular recanalisation in ELVO stroke.Trial registration numberNCT03820882.

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Training Guidelines for Endovascular Stroke Intervention: An International Multi-Society Consensus Document

Cited by 13 publications

References 22 publications

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

Comparing a novel Catfish flow restoration device and the Solitaire stent retriever for thrombectomy revascularisation in emergent largevessel occlusion stroke: a prospective randomised controlled study

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