Abstract WMP2: The Path from Research to Successful Implementation in Clinical Practice: Endovascular Treatment in the Netherlands

Abstract

Introduction: In the Netherlands, acute endovascular treatment (EVT) for ischemic stroke was not reimbursed andonly allowed as rescue treatment according to national guidelines until 2016. We describe the trend in use of EVT before, during and after the pivotal thrombectomy trials. Methods: Our study used data from all patients who were treated with EVT in the Netherlands from Jan 2002 until Jun 2016 in the Pretrial Registry, MR CLEAN trial and the ongoing MR CLEAN registry. We undertook a time-series analysis to examine trends in the use of EVT using a mixed-effects Poisson regression analysis and several observation plots. Rate ratios (RR) per quarter and 95% confidence intervals (95% CI) were obtained to demonstrate the impact and implementation after the publication of the trial. Regional plots were adjusted for exposure time and population density. Results: Between 2004 and 2010, 491 patients were treated with EVT in the Netherlands. In 2010, the MR CLEAN trial started. All hospitals providing EVT in the Netherlands included patients and reimbursement was conditional on participation in MR CLEAN. At first, a non-significant increase in EVT-treated patients was observed (RR: 4.6 [95%CI 0.1-9.1]). In 2015, an immediate steep increase in EVT-treated patients (RR: 20.9 [95%CI 5.5-30.1]) (Fig. 1) and a more even spread over the country was observed (Fig. 2). In the first years after the trial, 33% of the patients who were considered to be eligible for EVT were treated with EVT. Conclusion: A strict national policy regarding evidence based treatments can be successful. Ongoing efforts are directed at further increasing the proportion of stroke patients with EVT.

Changes in Stroke Hospital Care During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

“…The lack of difference in the rates of IVT administration for patients with acute ischemic stroke during the COVID-19 pandemic is in accordance with our previous meta-analysis, reporting no difference in the likelihood of IVT administration according to SARS-CoV-2 infection status. 6 The higher EVT rates observed in cohorts of patients admitted with acute ischemic stroke during the COVID-19 pandemic outbreak, highlighted in the present work, could potentially be explained by the constellation of higher LVO rates among stroke admissions, as reported also in the present meta-analysis and discussed above, the lower admission rates of patients with milder stroke syndromes, as highlighted by previous studies, 75,76 and the wider implementation of EVT over time 77 thereby leading to a relative, rather than an absolute, increase of EVT procedures per ischemic stroke admission during the COVID-19 outbreak periods in comparison to the prepandemic historical epochs. 78 The fact that more severe strokes are overrepresented in hospital admissions during the pandemic, as also highlighted by the present meta-analysis, could partially be attributed to the decrease of hospital admissions for transient ischemic attacks, mild and moderate strokes during the pandemic, as older people with milder strokes may not present to the hospital during the pandemic because of fear, neglect, or symptoms underestimation.…”

Advancements in diagnostic and interventional radiology for stroke treatment: the path from trial to bedside through the pre-MR CLEAN, MR CLEAN, and MR CLEAN II eras

“…In the Netherlands, this resulted in 3294 patients being treated with EVT between April 2014 and October 2017, which at that time was an exponential increase (Fig. 2 ) [ 24 ]. The same trend was seen in other countries.…”