Training guidelines for endovascular stroke intervention: an international multi-society consensus document

Lavine, S. D.; Cockroft, Kevin M.; Hoh, Brian L.; Bambakidis, Nicholas C.; Khalessi, Alexander A.; Woo, Hyeon-Jun; Riina, Howard A.; Siddiqui, Adnan H.; Hirsch, Joshua A; Chong, Winston; Rice, Henry E.; Wenderoth, Jason; Mitchell, Peter; Coulthard, Alan; Signh, T.J.; Phatorous, C.; Khangure, Makhan S.; Klurfan, Paula; Brugge, Karel ter; Iancu, Daniela; Gunnarsson, Þorsteinn; Jansen, Olav; Muto, Mario; Szikora, I; Piérot, Laurent; Brouwer, Patrick A.; Gralla, Jan; Renowden, Shelley; Andersson, Tommy; Fiehler, Jens; Turjman, Francis; White, Phil; Januel, Anne-Christine; Spelle, Laurent; Kulcsár, Zsolt; Chapot, René; Biondi, Alessandra; Dima, Sofia; Taschner, Christian; Szajner, Maciej; Krajina, Antonı́n; Sakai, Nobuyuki; Matsumaru, Yuji; Yoshimura, Shinichi; Ezura, Masayuki; Fujinaka, Toshiyuki; Iihara, K.; Ishii, Akira; Higashi, Toshio; Hirohata, Masaru; Hyodo, Akio; Ito, Yuhei; Kawanishi, Masahiko; Kiyosue, Hiro; Kobayashi, Eiichi; Kobayashi, Sei; Kuwayama, Naoya; Matsumoto, Yasushi; Miyachi, Shigeru; Murayama, Yuichi; Nagata, Izumi; Nakahara, Ichirō; Nemoto, Shigeru; Niimi, Y.; Oishi, Hidenori; Satomi, Junichiro; Satow, Tetsu; Sugiu, Kenji; Tanaka, Michihiro; Terada, Tomoaki; Yamagami, Hiroshi; Diaz, Orlando M.; Lylyk, Pedro; Jayaraman, Mahesh; Patsalides, Athos; Gandhi, Chirag D.; Lee, S. K.; Abruzzo, Todd; Albani, Barbara; Ansari, Sameer A; Arthur, Adam S; Baxter, Blaise; Bulsara, Ketan R.; Chen, M.; Almandoz, Josser E Delgado; Fraser, Justin F.; Heck, Don; Hetts, Steven W.; Hussain, Muhammad Shazam; Klucznik, Richard P.; Leslie-Mawzi, Thabele; Mack, William J.; McTaggart, Ryan; Meyers, Philip M.; Mocco, J; Prestigiacomo, Charles J.; Pride, G. Lee; Rasmussen, Peter A.; Starke, Robert M.; Sunenshine, Peter; Tarr, Robert W.; Frei, Donald; Ribó, Marc; Nogueira, Raul G; Zaidat, Osama O.; Jovin, T; Linfante, Italo; Yavagal, Dileep R.; Liebeskind, David S; Novakovic, Robin; Pongpech, Sirintara; Rodesch, Georges; Söderman, Michael; Taylor, Allan; Krings, Timo; Orbach, Darren B.; Picard, L; Suh, Dae Chul; Zhang, H. Q.

doi:10.1007/s00234-016-1667-0

Cited by 14 publications

(5 citation statements)

References 21 publications

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“…CSCs will require round the clock stroke physicians with expertise in endovascular stroke management, and fully trained neurointerventionalists with qualifications based on current models of certification. 21,22 Too many competing EVT centres will not be cost-effective, will compromise quality and will dilute the expertise of specialists. Universal adoption of a uniform definition of SUs and CSCs together with an appropriate certification process would help to guarantee the achievement of set quality targets throughout Europe.…”

Section: Discussionmentioning

confidence: 99%

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Sousa

Martial

Abilleira

et al. 2018

European Stroke Journal

250

200

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Introduction Acute stroke unit care, intravenous thrombolysis and endovascular treatment significantly improve the outcome for patients with ischaemic stroke, but data on access and delivery throughout Europe are lacking. We assessed best available data on access and delivery of acute stroke unit care, intravenous thrombolysis and endovascular treatment throughout Europe. Methods A survey, drafted by stroke professionals (ESO, ESMINT, EAN) and a patient organisation (SAFE), was sent to national stroke societies and experts in 51 European countries (World Health Organization definition) requesting experts to provide national data on stroke unit, intravenous thrombolysis and endovascular treatment rates. We compared both pooled and individual national data per one million inhabitants and per 1000 annual incident ischaemic strokes with highest country rates. Population estimates were based on United Nations data, stroke incidences on the Global Burden of Disease Report. Results We obtained data from 44 European countries. The estimated mean number of stroke units was 2.9 per million inhabitants (95% CI 2.3–3.6) and 1.5 per 1000 annual incident strokes (95% CI 1.1–1.9), highest country rates were 9.2 and 5.8. Intravenous thrombolysis was provided in 42/44 countries. The estimated mean annual number of intravenous thrombolysis was 142.0 per million inhabitants (95% CI 107.4–176.7) and 72.7 per 1000 annual incident strokes (95% CI 54.2–91.2), highest country rates were 412.2 and 205.5. Endovascular treatment was provided in 40/44 countries. The estimated mean annual number of endovascular treatments was 37.1 per million inhabitants (95% CI 26.7–47.5) and 19.3 per 1000 annual incident strokes (95% CI 13.5–25.1), highest country rates were 111.5 and 55.9. Overall, 7.3% of incident ischaemic stroke patients received intravenous thrombolysis (95% CI 5.4–9.1) and 1.9% received endovascular treatment (95% CI 1.3–2.5), highest country rates were 20.6% and 5.6%. Conclusion We observed major inequalities in acute stroke treatment between and within 44 European countries. Our data will assist decision makers implementing tailored stroke care programmes for reducing stroke-related morbidity and mortality in Europe.

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Section: Discussionmentioning

confidence: 99%

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Sousa

Martial

Abilleira

et al. 2018

European Stroke Journal

250

200

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6] Updated guidelines recommend TBY as a level 1 evidencebased treatment. [7][8][9] Implementation of system reorganisation that allows rapid delivery of TBY to all eligible patients is a challenge that currently is under development in many geographical areas and may require substantial investment of scarce resources. 10 Four earlier cost-effectiveness studies have extrapolated RCT-data and reported that TBY is likely a costeffective strategy.…”

Section: Introductionmentioning

confidence: 99%

Long-term cost-effectiveness of thrombectomy for acute ischaemic stroke in real life: An analysis based on data from the Swedish Stroke Register (Riksstroke)

Carlsson

Andsberg

Petersson

et al. 2017

International Journal of Stroke

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Background Randomised controlled trials have demonstrated substantial clinical benefit for thrombectomy in patients with acute ischaemic stroke and proximal anterior circulation arterial occlusion. Aim We investigated the long-term cost-effectiveness of thrombectomy after thrombolysis versus thrombolysis alone using real-world outcome data on need for health care, home help and nursing home care. Methods We used real-life resource use and survival data from the Swedish Stroke Register and pooled outcomes from five randomised controlled trials published in 2015 in a newly constructed Markov cost-effectiveness model with a societal perspective. Data were stratified by age (18-64; 65-74; 75-84 years) and modified Rankin scale at three months for patients with an index ischaemic stroke in 2014 fulfilling inclusion criteria NIHSS ≥ 8 before treatment and treated with thrombolysis ( n = 710). Univariate sensitivity analyses explored robustness of results. A life-time perspective and 3% discount rate were applied. Results Thrombectomy increases the health care cost per patient (+GBP 9000) mainly because of intervention costs, but the reduced burden on the social services (home help services -GBP 13,000; nursing home care -GBP 26,000) implies overall cost savings. The average patient gain was 1.0 quality-adjusted life year (QALY) with higher gains for younger age groups. Thrombectomy was a dominant strategy in the base case and all sensitivity analyses where social services were considered. Conclusion Thrombectomy has a small effect on hospital costs except for the direct intervention cost. However, thrombectomy is highly likely to lead to substantial cost savings in the social service sector, up to four times the increase in health-care costs.

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“…Although few studies have investigated stroke teams' and interventionalists' training and experience and their effects on outcome, it is likely that they lead to improved reperfusion grades and shorter procedure times. 31 The observed improvement is unlikely to have been caused by stricter patient selection only. The number of performed EVT procedures did not decline over time, the proportion of patients with mRS score 5 and 6 stayed the same, and the only baseline differences were higher age, a less frequent history of myocardial infarction, poorer collateral scores, higher ASPECTS, and more distal occlusions (specifically more M2-occlusions) in patients from the second cohort; some of these even indicate a less strict selection.…”

Section: Discussionmentioning

confidence: 89%

“…Although few studies have investigated stroke teams’ and interventionalists’ training and experience and their effects on outcome, it is likely that they lead to improved reperfusion grades and shorter procedure times. 31 …”

Section: Discussionmentioning

confidence: 99%

Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

Compagne

Kappelhof

Hinsenveld

et al. 2022

Stroke

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Background: We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes. Methods: We included patients with proximal occlusions of the anterior circulation from the second and first cohorts of the MR CLEAN (Multicenter Randomized Clinical trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry (March 2014 to June 2016; June 2016 to November 2017, respectively). We compared workflow times and rates of successful reperfusion (defined as an extended thrombolysis in cerebral infarction score of 2B-3) between cohorts and chronological quartiles (all included patients stratified in chronological quartiles of intervention dates to create equally sized groups over the study period). Multivariable ordinal logistic regression was used to assess differences in the primary outcome (ordinal modified Rankin Scale at 90 days). Results: Baseline characteristics were similar between cohorts (second cohort n=1692, first cohort n=1488) except for higher age, poorer collaterals, and less signs of early ischemia on computed tomography in the second cohort. Time from stroke onset to groin puncture and reperfusion were shorter in the second cohort (median 185 versus 210 minutes; P <0.001 and 236 versus 270 minutes; P <0.001, respectively). Successful reperfusion was achieved more often in the second than in the first cohort (72% versus 66%; P <0.001). Functional outcome significantly improved (adjusted common odds ratio 1.23 [95% CI, 1.07–1.40]). This effect was attenuated by adjustment for time from onset to reperfusion (adjusted common odds ratio, 1.12 [95% CI, 0.98–1.28]) and successful reperfusion (adjusted common odds ratio, 1.13 [95% CI, 0.99–1.30]). Outcomes were consistent in the analysis per chronological quartile. Conclusions: Clinical outcomes after endovascular treatment for acute ischemic stroke in routine clinical practice have improved over the past years, likely resulting from improved workflow times and higher successful reperfusion rates.

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Training guidelines for endovascular stroke intervention: an international multi-society consensus document

Cited by 14 publications

References 21 publications

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Access to and delivery of acute ischaemic stroke treatments: A survey of national scientific societies and stroke experts in 44 European countries

Long-term cost-effectiveness of thrombectomy for acute ischaemic stroke in real life: An analysis based on data from the Swedish Stroke Register (Riksstroke)

Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

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