Mandatory Neuroendovascular Evolution: Meeting the New Demands

Abstract

Background: Traditionally, patients undergoing acute ischemic strokes were candidates for mechanical thrombectomy if they were within the 6-h window from onset of symptoms. This timeframe would exclude many patient populations, such as wake-up strokes. However, the most recent clinical trials, DAWN and DEFUSE3, have expanded the window of endovascular treatment for acute ischemic stroke patients to within 24 h from symptom onset. This expanded window increases the number of potential candidates for endovascular intervention for emergent large vessel occlusions and raises the question of how to efficiently screen and triage this increase of patients. Summary: Abbreviated pre-hospital stroke scales can be used to guide EMS personnel in quickly deciding if a patient is undergoing a stroke. Telestroke networks connect remote hospitals to stroke specialists to improve the transportation time of the patient to a comprehensive stroke center for the appropriate level of care. Mobile stroke units, mobile interventional units, and helistroke reverse the traditional hub-and-spoke model by bringing imaging, tPA, and expertise to the patient. Smartphone applications and social media aid in educating patients and the public regarding acute and long-term stroke care. Key Messages: The DAWN and DEFUSE3 trials have expanded the treatment window for certain acute ischemic stroke patients with mechanical thrombectomy and subsequently have increased the number of potential candidates for endovascular intervention. This expansion brings patient screening and triaging to greater importance, as reducing the time from symptom onset to decision-to-treat and groin puncture can better stroke patient outcomes. Several strategies have been employed to address this issue by reducing the time of symptom onset to decision-to-treat time.

Effect of Operator’s Experience on Proficiency in Mechanical Thrombectomy: A Multicenter Study

“…13 Our study in that sense highlights that, even in trained neuro-interventionists, operating in autonomy, increasing experience in EVT is associated with better procedural metrics. The optimal balance between procedural efficiency and safety, and the growing need for thrombectomy-trained interventionalists 23,24 is still to be found. Our study contributes to the evidence that MT is a high-level technical procedure, with enhanced procedural metrics as operator's experience increases, and prompts caution with regards to degraded trainings.…”

Stroke Scales as Assessment Tools in Emergency Settings: A Narrative Review

“…The FAST-ED scale has a higher predictive value for strokes related to large vessel occlusion and eligible candidates for mechanical revascularization (thrombectomy) [15]. Currently, in prehospital settings, there are several stroke scales that can guide emergency medical staff in triaging patients with acute stroke [16]. Commonly used scales are the following: (1) the 3-item stroke scale (3I-SS), (2) the Austrian Prehospital Stroke Scale (APSS), (3) the Cincinnati Prehospital Stroke Scale (CPSS), (4) the Los Angeles Stroke Screen (LAPSS), (5) the Rapid Arterial Occlusion Evaluation (RACE) scale, and (6) the shortened NIHSS for EMS (sNIHSS-EMS) [16][17][18].…”

“…Currently, in prehospital settings, there are several stroke scales that can guide emergency medical staff in triaging patients with acute stroke [16]. Commonly used scales are the following: (1) the 3-item stroke scale (3I-SS), (2) the Austrian Prehospital Stroke Scale (APSS), (3) the Cincinnati Prehospital Stroke Scale (CPSS), (4) the Los Angeles Stroke Screen (LAPSS), (5) the Rapid Arterial Occlusion Evaluation (RACE) scale, and (6) the shortened NIHSS for EMS (sNIHSS-EMS) [16][17][18]. In recent years, there has been more focus on the identification of large vessel occlusion (LVO) strokes, which are candidates for mechanical revascularization procedures [7].…”