Thrombectomy stroke centers: The current threat to regionalizing stroke care

Mack, William J.; Mocco, J; Hirsch, Joshua A; Chen, Michael; Elijovich, Lucas; Tarr, Robert W.; Albuquerque, Felipe C

doi:10.1136/neurintsurg-2017-013721

Cited by 22 publications

(19 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results of this pooled analysis, therefore, confirm the previous publications of each individual stroke network, which were mostly single center analyses. This study adds evidence that the EXT concept may be a good alternative to the well established DS concept if certain requirements are met 28. The EVEREST collaboration therefore encourages stroke networks to consider the EXT concept as a third triage pathway 29…”

Section: Discussionmentioning

confidence: 76%

Transferring neurointerventionalists saves time compared with interhospital transfer of stroke patients for endovascular thrombectomy: a collaborative pooled analysis of 1001 patients (EVEREST)

Şeker

Fifi

Morey

et al. 2022

J NeuroIntervent Surg

View full text Add to dashboard Cite

BackgroundInterhospital transfer of stroke patients (drip and ship concept) is associated with longer treatment times compared with primary admission to a comprehensive stroke center (mothership concept). In recent years, studies on a novel concept of performing endovascular thrombectomy (EVT) at external hospitals (EXT) by transferring neurointerventionalists, instead of patients, have been published. This collaborative study aimed at answering the question of whether EXT saves time in the workflow of acute stroke treatment across various geographical regions.MethodsThis was a patient level pooled analysis of one prospective observational study and four retrospective cohort studies, the EVEREST collaboration (EndoVascular thrombEctomy at Referring and External STroke centers). Time from initial stroke imaging to EVT (vascular puncture) was compared in mothership, drip and ship, and EXT concepts.ResultsIn total, 1001 stroke patients from various geographical regions who underwent EVT due to large vessel occlusion were included. These were divided into mothership (n=162, 16.2%), drip and ship (n=458, 45.8%), and EXT (n=381, 38.1%) cohorts. The median time periods from onset to EVT (195 min vs 320 min, p<0.001) and from imaging to EVT (97 min vs 184 min, p<0.001) in EXT were significantly shorter than for drip and ship thrombectomy concept.ConclusionsThis pooled analysis of the EVEREST collaboration adds evidence that performing EVT at external hospitals can save time compared with drip and ship across various geographical regions. We encourage conducting randomized controlled trials comparing both triage concepts.

show abstract

Section: Discussionmentioning

confidence: 76%

Transferring neurointerventionalists saves time compared with interhospital transfer of stroke patients for endovascular thrombectomy: a collaborative pooled analysis of 1001 patients (EVEREST)

Şeker

Fifi

Morey

et al. 2022

J NeuroIntervent Surg

View full text Add to dashboard Cite

show abstract

“…Second, thrombectomy-capable centers were treated in a similar way as comprehensive stroke centers, although it is unclear whether these centers are able to maintain the same level of experience and high standards of care. 28 Third, local differences in door-in-door-out time and door-to-groin time might affect the optimal transportation strategy, but due to a lack of data we had to use the average workflow times reported for primary stroke centers and intervention centers. Fourth, we assumed that outcomes of non-LVO stroke patients are similar after transportation to a primary stroke center or intervention center.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Triage Strategies for the Transportation of Suspected Stroke Patients in the United States

Venema

Burke

Roozenbeek

et al. 2020

Stroke

View full text Add to dashboard Cite

Background and Purpose: Ischemic stroke patients with large vessel occlusion (LVO) could benefit from direct transportation to an intervention center for endovascular treatment, but non-LVO patients need rapid IV thrombolysis in the nearest center. Our aim was to evaluate prehospital triage strategies for suspected stroke patients in the United States. Methods: We used a decision tree model and geographic information system to estimate outcome of suspected stroke patients transported by ambulance within 4.5 hours after symptom onset. We compared the following strategies: (1) Always to nearest center, (2) American Heart Association algorithm (ie, directly to intervention center if a prehospital stroke scale suggests LVO and total driving time from scene to intervention center is <30 minutes, provided that the delay would not exclude from thrombolysis), (3) modified algorithms with a maximum additional driving time to the intervention center of <30 minutes, <60 minutes, or without time limit, and (4) always to intervention center. Primary outcome was the annual number of good outcomes, defined as modified Rankin Scale score of 0–2. The preferred strategy was the one that resulted in the best outcomes with an incremental number needed to transport to intervention center (NNTI) <100 to prevent one death or severe disability (modified Ranking Scale score of >2). Results: Nationwide implementation of the American Heart Association algorithm increased the number of good outcomes by 594 (+1.0%) compared with transportation to the nearest center. The associated number of non-LVO patients transported to the intervention center was 16 714 (NNTI 28). The modified algorithms yielded an increase of 1013 (+1.8%) to 1369 (+2.4%) good outcomes, with a NNTI varying between 28 and 32. The algorithm without time limit was preferred in the majority of states (n=32 [65%]), followed by the algorithm with <60 minutes delay (n=10 [20%]). Tailoring policies at county-level slightly reduced the total number of transportations to the intervention center (NNTI 31). Conclusions: Prehospital triage strategies can greatly improve outcomes of the ischemic stroke population in the United States, but increase the number of non-LVO stroke patients transported to an intervention center. The current American Heart Association algorithm is suboptimal as a nationwide policy and should be modified to allow more delay when directly transporting LVO-suspected patients to an intervention center.

show abstract

“…Recently, a new level of care, Thrombectomy-Capable Stroke Centers (TSC), which falls between CSC and PSC has been established in light of the community need for greater access to thrombectomy [72]. However, the proper role of TSCs in the overall stroke system of care remains a controversy as some have raised the concern that inclusion of TSCs in urban areas with CSCs may lead to a lower quality of care by diluting volumes across the system [73,74].…”

Section: Access To Carementioning

confidence: 99%

Recanalization Therapy for Acute Ischemic Stroke with Large Vessel Occlusion: Where We Are and What Comes Next?

Shafie

2021

Transl. Stroke Res.

View full text Add to dashboard Cite

In the past 5 years, the success of multiple randomized controlled trials of recanalization therapy with endovascular thrombectomy has transformed the treatment of acute ischemic stroke with large vessel occlusion. The evidence from these trials has now established endovascular thrombectomy as standard of care. This review will discuss the chronological evolution of large vessel occlusion treatment from early medical therapy with tissue plasminogen activator to the latest mechanical thrombectomy. Additionally, it will highlight the potential areas in endovascular thrombectomy for acute ischemic stroke open to exploration and further progress in the next decade.

show abstract

Thrombectomy stroke centers: The current threat to regionalizing stroke care

Cited by 22 publications

References 18 publications

Transferring neurointerventionalists saves time compared with interhospital transfer of stroke patients for endovascular thrombectomy: a collaborative pooled analysis of 1001 patients (EVEREST)

Transferring neurointerventionalists saves time compared with interhospital transfer of stroke patients for endovascular thrombectomy: a collaborative pooled analysis of 1001 patients (EVEREST)

Prehospital Triage Strategies for the Transportation of Suspected Stroke Patients in the United States

Recanalization Therapy for Acute Ischemic Stroke with Large Vessel Occlusion: Where We Are and What Comes Next?

Contact Info

Product

Resources

About