Mechanical Thrombectomy-Ready Comprehensive Stroke Center Requirements and Endovascular Stroke Systems of Care: Recommendations from the Endovascular Stroke Standards Committee of the Society of Vascular and Interventional Neurology (SVIN)

Abstract

Five landmark multicenter, prospective, randomized, open-label, blinded end point clinical trials have recently demonstrated significant clinical benefit of endovascular therapy with mechanical thrombectomy in acute ischemic stroke (AIS) patients presenting with proximal intracranial large vessel occlusions. The Society of Vascular and Interventional Neurology (SVIN) appointed an expert writing committee to summarize this new evidence and make recommendations on how these data should guide emergency endovascular therapy for AIS patients.

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

“…The European and Canadian guidelines have similarly been updated to reflect this [8,9]. However, the delivery of ECR requires 24-h rapid access to clinical stroke expertise, neuroimaging and a comprehensive system of neurointerventionists, access to neuroangiography suite and a sizeable support team including angiography nursing, radiographers and anaesthetists [10,11]. The maintenance of such a system requires a centralized approach and high volume of cases for skills maintenance [11,12].…”

“…However, the delivery of ECR requires 24-h rapid access to clinical stroke expertise, neuroimaging and a comprehensive system of neurointerventionists, access to neuroangiography suite and a sizeable support team including angiography nursing, radiographers and anaesthetists [10,11]. The maintenance of such a system requires a centralized approach and high volume of cases for skills maintenance [11,12]. This has important implications for stroke service delivery systems to ensure patients have expedited access to ECR [13].…”

Practice makes perfect: establishing reasonable minimum thrombectomy volume requirements for stroke centers

“…Based on these data, consensus documents from 2015 have recommended that PPCI for ST-elevation myocardial infarction be performed by operators that perform more than 11 PPCI procedures per year at centers that perform at least 36 PPCI procedures per year 36. These recommendations are similar to the Society of Vascular and Interventional Neurology recommendations, which state that CSC certification requires at least 25–30 NT procedures per center per year and a minimum of 10 NT procedures per operator per year 51. Furthermore, these recommendations are similar to natural NT mortality thresholds for high-volume centers (35.2 cases per year) calculated in regression tree analysis in the Rinaldo study 31…”

New hospital structure in the twenty-first century: the position of level III (tertiary) neurological and stroke care in a changing healthcare system

“…The biggest issue in deciding between secondary or tertiary stroke care is the triage before hospital admission, and how we can select those patients, who are eligible for thrombectomy (English et al 2016). Recently, there’s no widely accepted method for that, and some patients primarily admitted to a secondary level neurology ward must be transferred to a tertiary ward, or a thrombectomy center, after the initial brain CT or CT angiography.…”