Endovascular Thrombectomy and Stroke Physicians

Davis, Stephen M.; Campbell, Bruce; Donnan, Geoffrey A

doi:10.1161/strokeaha.117.018208

Cited by 19 publications

(13 citation statements)

References 14 publications

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“…With further improvements and clinical validations, we envision that the algorithm developed in this study may be used for building a triage and fast response system where it can provide a shorter time to mechanical thrombectomy and also a faster time to transfer from a peripheral hospital to a tertiary stroke center, so that the relevant procedure can be performed. This would present a significant clinical benefit because there is a shortage of interventional neuroradiologists [ 40 ] and the automated DWI-ASPECTS assessment can help accelerate the procedure of identifying patients who need an interventional neuroradiologist’s consultation. Most recently, Viz LVO (Viz.ai, Inc. San Francisco CA, USA), which is software with the similar aim to improve the triage and shorten the time-to-treatment for stroke patients using CT angiography, became the first artificial intelligence-based software to receive the Medicare New Technology Add-on Payment (NTAP) by the Centers for Medicare & Medicaid Services [ 41 , 42 ].…”

Section: Discussionmentioning

confidence: 99%

Automatic Assessment of ASPECTS Using Diffusion-Weighted Imaging in Acute Ischemic Stroke Using Recurrent Residual Convolutional Neural Network

Baek

Kim

et al. 2020

Diagnostics

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The early detection and rapid quantification of acute ischemic lesions play pivotal roles in stroke management. We developed a deep learning algorithm for the automatic binary classification of the Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) using diffusion-weighted imaging (DWI) in acute stroke patients. Three hundred and ninety DWI datasets with acute anterior circulation stroke were included. A classifier algorithm utilizing a recurrent residual convolutional neural network (RRCNN) was developed for classification between low (1–6) and high (7–10) DWI-ASPECTS groups. The model performance was compared with a pre-trained VGG16, Inception V3, and a 3D convolutional neural network (3DCNN). The proposed RRCNN model demonstrated higher performance than the pre-trained models and 3DCNN with an accuracy of 87.3%, AUC of 0.941, and F1-score of 0.888 for classification between the low and high DWI-ASPECTS groups. These results suggest that the deep learning algorithm developed in this study can provide a rapid assessment of DWI-ASPECTS and may serve as an ancillary tool that can assist physicians in making urgent clinical decisions.

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Section: Discussionmentioning

confidence: 99%

Automatic Assessment of ASPECTS Using Diffusion-Weighted Imaging in Acute Ischemic Stroke Using Recurrent Residual Convolutional Neural Network

Baek

Kim

et al. 2020

Diagnostics

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“…Since endovascular thrombectomy became the standard-of-care for LVO stroke in 2015, healthcare systems across the world were faced with the significant challenge of enabling equitable and universal access to thrombectomy amidst varied degrees of logistical and resource constraints. 2 Understanding the populationspecific incidence of LVO is essential for deciding healthcare resource allocation and stroke service planning.…”

Section: Discussionmentioning

confidence: 99%

“…1 Establishing a comprehensive acute stroke service with universal access to thrombectomy has become a public health priority and challenge worldwide. 2 Available data on the epidemiology of LVO stroke are based on Western populations and the respective incidence in Asian countries is largely unknown. This information is essential for the understanding of the disease burden and healthcare service planning.…”

Section: Introductionmentioning

confidence: 99%

Burden of large vessel occlusion stroke and the service gap of thrombectomy: A population-based study using a territory-wide public hospital system registry

Tsang

You

et al. 2019

International Journal of Stroke

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Background Ischemic stroke due to large vessel occlusion can be effectively treated with thrombectomy but access to this treatment is limited in many parts of the world. Local incidence of large vessel occlusion is critical in determining the development of thrombectomy service, but reliable data from Asian countries are lacking. Aims We performed a population-based study to estimate the burden of large vessel occlusion and the service gap for thrombectomy in Hong Kong. Methods All acute ischemic stroke patients admitted in 2016 to the public healthcare system, which provided 90% of the emergency healthcare in the city, was identified from the Hong Kong Hospital Authority’s central electronic database. The diagnosis of large vessel occlusion was retrospectively verified by two independent cerebrovascular specialists in a randomly sampled cohort based on clinical and neuroimaging data. The incidence of large vessel occlusion in the population was estimated through weighting the sample results and compared with the thrombectomy data in the same period. Results There were 6859 acute ischemic stroke patients treated in the public health system in 2016. Amongst the 300 patients randomly sampled according to diagnosis coding, 130 suffered from anterior circulation large vessel occlusion. This translated to 918 patients (95% CI 653–1180) and 13.3% of all ischemic stroke patients. The estimated incidence of anterior circulation large vessel occlusion was 12.5 per 100,000 persons per year (95% CI 11.7–13.4). Large vessel occlusion stroke patients were more commonly female than male (67.4% vs. 31.6%, p = 0.003), and were older than non-large vessel occlusion stroke patients (mean of 80.5 years vs. 71.4 years, p = < 0.001). They also had higher 30-day mortality rate (31.1% vs. 4.6%, p = < 0.001), and longer hospital stay (mean 38.6 vs. 21.1 days, p = 0.003) than non-large vessel occlusion stroke. In the same period, 83 thrombectomies for large vessel occlusion were performed, representing 9.1% of the estimated large vessel occlusion incidence. Conclusion The estimated incidence of anterior circulation large vessel occlusion in the Hong Kong Chinese population is lower than that in the West. There is however a substantial service gap for endovascular thrombectomy with less than 10% of large vessel occlusion patients receiving thrombectomy.

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“…Neither approach addresses the issues of adequate physician numbers to perform EVT or the geographic distribution of interventional physicians. The shortage of physicians and comprehensive stroke centers providing EVT has been confirmed by the stroke neurology community (30,31), who recommend that patients be treated locally rather than having long transfer delays.…”

mentioning

confidence: 99%

The Role of Interventional Radiologists in Acute Ischemic Stroke Interventions: A Joint Position Statement from the Society of Interventional Radiology, the Cardiovascular and Interventional Radiology Society of Europe, and the Interventional Radiology Society of Australasia

Sacks

Overhagen

Zwam

et al. 2019

Journal of Vascular and Interventional Radiology

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Stroke is a major public health issue. Worldwide, the incidence of new strokes is 16.9 million per year (1). In the United States, the incidence of new strokes is 795,000 per year, of which 87% are ischemic (2). Endovascular thrombectomy (EVT) is proven to provide better clinical outcomes in patients with ischemic strokes caused by large-vessel occlusion compared with best medical therapy alone (3-12). Furthermore, endovascular thrombectomy has proven to be cost-effective (13). The American Heart Association (AHA) and multiple international stroke organizations

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Endovascular Thrombectomy and Stroke Physicians

Cited by 19 publications

References 14 publications

Automatic Assessment of ASPECTS Using Diffusion-Weighted Imaging in Acute Ischemic Stroke Using Recurrent Residual Convolutional Neural Network

Automatic Assessment of ASPECTS Using Diffusion-Weighted Imaging in Acute Ischemic Stroke Using Recurrent Residual Convolutional Neural Network

Burden of large vessel occlusion stroke and the service gap of thrombectomy: A population-based study using a territory-wide public hospital system registry

The Role of Interventional Radiologists in Acute Ischemic Stroke Interventions: A Joint Position Statement from the Society of Interventional Radiology, the Cardiovascular and Interventional Radiology Society of Europe, and the Interventional Radiology Society of Australasia

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