Every 15-Min Delay in Recanalization by Intra-Arterial Therapy in Acute Ischemic Stroke Increases Risk of Poor Outcome

He, Anna; Чурилов, Леонид; Mitchell, Peter; Dowling, Richard; Yan, Bernard

doi:10.1111/ijs.12495

Cited by 34 publications

(19 citation statements)

References 26 publications

(36 reference statements)

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“…Time to treatment also plays a significant role: In our study, the elderly patient group had 30-min longer prehospital times and it took 45 min longer to achieve recanalization. It has been shown that time is of the essence in EVT and even minor delays can lead to worsened clinical outcome [30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Endovascular Thrombectomy in the Elderly: Do Radiological and Clinical Outcomes Differ from Those in Younger Patients? A Prospective Single-Center Experience

et al. 2019

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Objectives: Endovascular treatment (EVT) has emerged as the gold standard therapy for stroke due to large vessel occlusion (LVO). There is however limited evidence to suggest that similar efficacy can be expected in elderly patients. We aimed to assess the efficacy and safety of EVT in elderly patients (aged > 80), comparing outcomes to younger patients (aged < 80). Material and Methods: A total of 195 patients with LVO stroke treated with EVT were included and dichotomized by age. We compared neurological improvement, clinical 90 day outcome, technical recanalization rates, procedure-related complications, and mortality in between the groups. Results: Both groups showed equally marked neurological improvement. A favorable outcome modified Rankin Scale (mRS < 2) was seen in 28% of the elderly patients compared to 46% of the younger patients (p = 0.01). mRS 0–3 was seen in 46% of the elderly patients and 58% of the younger patients (p = 0.09). The rates of successful technical recanalization did not differ between the groups and there were no differences in procedural complication rates or incidence of symptomatic intracranial bleeding. Three-month mortality rates were however higher in the elderly group. Conclusions: EVT in the elderly resulted in equally notable neurological improvement as compared to younger patients. Although the elderly had a higher mortality rate and fewer favorable clinical outcomes at 3 month follow-up, a strict upper age limit for EVT seems unjustified.

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Section: Discussionmentioning

confidence: 99%

Endovascular Thrombectomy in the Elderly: Do Radiological and Clinical Outcomes Differ from Those in Younger Patients? A Prospective Single-Center Experience

et al. 2019

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“…Benefits of ECR have now been proven in 6 randomised controlled trials, but results are time-critical [21] and it is a technically challenging procedure that is performed only in a limited number of hospitals in Australia. The advantages of a "hub-and-spoke" (or "drip-and-ship") model are having the volume to maintain experience, continue research and training and reduce the burden of after-hours service provision.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Clot Retrieval by Hub-and-Spoke Service Delivery is Feasible Compared with Direct-to-Mothership

et al. 2018

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Background: Endovascular clot retrieval (ECR) improves outcomes for acute ischaemic stroke with large artery occlusion. However, the provision of ECR requires resource-intensive comprehensive stroke centres (CSC), which are impractical to establish in regional hospitals. An alternative is a “hub-and-spoke” model, whereby ischaemic strokes are triaged at the regional primary centres and where eligible, transferred to a CSC. We aimed to compare the outcomes of patients directly admitted to a CSC with patients treated in the “hub-and-spoke” model. We hypothesize that there are no significant differences in clinical outcomes between the 2 systems. Methods: We included patients undergoing ECR at a CSC. Patients were categorised into 2 groups; the first group included patients directly admitted to the CSC and the second group included patients in the “hub-and-spoke” model. Good clinical outcome was defined as modified Rankin Scale 0–2 and the difference between the 2 groups was tested by logistic regression. Results: Of 178 patients, 50 (28%) presented directly to CSC and 128 (72%) were transferred from a referring hospital. The median age was 70 (interquartile range 58–77) and 61% were male. Thrombolysis in ischaemic cerebral-infarction 2b/3 recanalisation was achieved in 79% of patients. Of the direct group, 63% (95% CI 48–77%) achieved good clinical outcomes compared to 52% (95% CI 43–61%) in the “hub-and-spoke” group (p = 0.233). Conclusion: This state-wide service model demonstrates comparable clinical outcomes to that described in clinical trials. We found no significant difference in outcome between patients directly admitted to CSC and those with “hub-and-spoke” service delivery.

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“…Additional specialists participating could reduce on-call frequency. A follow-the-sun model [ 26 ] where specialists in other time-zones can provide remote consultations (e.g. Australia supports UK) could limit out-of-hours disruption and support specialists’ retention.…”

Section: Discussionmentioning

confidence: 99%

Integrating acute stroke telemedicine consultations into specialists’ usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom

Bagot

Cadilhac

Bladin

et al. 2017

BMC Health Serv Res

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BackgroundStroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations.MethodsSpecialist participants were identified using purposive sampling from two new services: Australia’s Victorian Stroke Telemedicine Program (n = 6; 2010–13) and the United Kingdom’s Cumbria and Lancashire telestroke network (n = 5; 2010–2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70.ResultsCross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures.ConclusionAustralian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.

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Every 15-Min Delay in Recanalization by Intra-Arterial Therapy in Acute Ischemic Stroke Increases Risk of Poor Outcome

Abstract: Longer time to recanalization was associated with poorer functional outcome post intra-arterial therapy. We recommend that a systematic approach to minimize time delay to treatment is warranted in intra-arterial therapy for acute ischemic stroke.

Cited by 34 publications

References 26 publications

Endovascular Thrombectomy in the Elderly: Do Radiological and Clinical Outcomes Differ from Those in Younger Patients? A Prospective Single-Center Experience

Endovascular Thrombectomy in the Elderly: Do Radiological and Clinical Outcomes Differ from Those in Younger Patients? A Prospective Single-Center Experience

Endovascular Clot Retrieval by Hub-and-Spoke Service Delivery is Feasible Compared with Direct-to-Mothership

Integrating acute stroke telemedicine consultations into specialists’ usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom

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