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Liu Z, Leong MQ, Li N, Teo MM, Leong WLR, Wong SCP, Chew JS, Saffari SE, Pang YH, Chia GS. Reducing Door-to-Puncture Times for Mechanical Thrombectomy in a Large Tertiary Hospital. Neurol Clin Pract 2024; 14:e200325. [PMID: 38939047 PMCID: PMC11201277 DOI: 10.1212/cpj.0000000000200325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/02/2024] [Indexed: 06/29/2024]
Abstract
Background and Objectives Endovascular therapy (EVT) for stroke has emerged as an important therapy for selected stroke patients, and shorter times to clot removal improve functional outcomes. EVT requires the close coordination of multiple departments and poses unique challenges to care coordination in large hospitals. We present the results of our quality improvement project that aimed to improve our door-to-groin puncture (DTP) times for patients who undergo EVT after direct presentation to our emergency department. Methods We conducted time-motion studies to understand the full process of an EVT activation and conducted Gemba walks in multiple hospitals. We also reviewed the literature and interviewed stakeholders to create interventions that were implemented over 4 Plan-Do-Study-Act (PDSA) cycles. We retrospectively collected data starting from baseline and during every PDSA cycle. During each cycle, we studied the impact of the interventions, adjusted the interventions, and generated further interventions. A variety of interventions were introduced targeting all aspects of the EVT process. This included parallel processing to reduce waiting time, standardization of protocols and training of staff, behavioral prompts in the form of a stroke clock, and push systems to empower staff to facilitate the forward movement of the patient. A novel role-based communication app to facilitate group communications was also used. Results Eighty-eight patients spanning across 22 months were analyzed. After the final PDSA cycle, the median DTP time was reduced by 36.5% compared with baseline (130 minutes (interquartile range [IQR] 111-140) to 82.5 minutes (IQR 74.8-100)). There were improvements in all phases of the EVT process with the largest time savings occurring in EVT decision to patient arrival at the angiosuite. Interventions that were most impactful are described. Discussion EVT is a complex process involving multiple processes and local factors. Analysis of the process from all angles and intervening on multiple small aspects can add up to significant improvements in DTP times.
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Affiliation(s)
- Zhenghong Liu
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Man Qing Leong
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Nanlan Li
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Miqi Mavis Teo
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Wei-Li Rachel Leong
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Steve Chen Pong Wong
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Jing Si Chew
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Seyed Ehsan Saffari
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Yee Hau Pang
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
| | - Ghim Song Chia
- Department of Emergency Medicine (ZL), Singapore General Hospital; Inpatient Operations (MQL), Changi General Hospital; Office of Clinical Informatics (NL), Woodlands Health; Division of Anaesthesiology and Peiroperative Medicine (MMT, W-LRL); Department of Neuroradiology (SCPW, GSC); Department of Neurology (JSC, YHP), Singapore General Hospital; and Center for Quantitative Medicine (SES), Duke-NUS Medical School, Singapore
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Bhatt NR, Martin-Gill C, Al-Qudah A, Dermigny K, Doheim MF, Rios Rocha L, Sultany A, Kakamyradov G, Rocha M, Starr M, Patterson R, Al-Bayati AR, Guyette FX, Nogueira RG. Acquisition of Prehospital Stroke Severity Scale is associated with shorter door-to-puncture times in patients with prehospital notifications transported directly to a thrombectomy center. J Neurointerv Surg 2024:jnis-2024-022122. [PMID: 39299743 DOI: 10.1136/jnis-2024-022122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/28/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND We sought to identify systemic factors influencing door-to-puncture times (DTP) among patients with pre-arrival notifications presenting directly to a comprehensive stroke center (CSC) and undergoing emergent mechanical thrombectomy (MT). METHODS In this retrospective analysis of a prospectively maintained registry of acute ischemic stroke (AIS) patients undergoing MT at two CSCs between January 2021 and October 2023, we included consecutive AIS patients presenting directly to the CSC with pre-arrival notifications via emergency medical services (EMS) and who underwent emergent MT. We excluded patients with known confounders to DTP and divided this cohort into two groups: DTP ≤75 min and >75 min. We used variables with P value <0.2 in the univariate analysis to build a binary logistic regression model to identify their association with DTP >75 min, adjusting for door-to-CT time. RESULTS Of 900 patients, 605 were inter-facility transfers, 89 were excluded due to known confounders/missing prehospital notifications, leaving 206 qualifying patients. On multivariable analysis, not meeting American Heart Association (AHA) level 1 criteria (adjusted OR (aOR) 3.04, 95% CI 1.62 to 5.82, P<0.001), lack of Prehospital Stroke Severity Scale (PSSS) acquisition (aOR 2.2, 95% CI 1.19 to 4.11, P=0.01), and presentation after-hours (aOR 2.27, 95% CI 1.23 to 4.28, P=0.01) were associated with >75 min DTP times. Most patients (62.3%) had no clearly documented reasons for delay in MT, whereas 25.8% of delays were attributed to prolonged medical decision-making. CONCLUSION Arrival outside business hours, not meeting AHA level 1 criteria, and lack of PSSS acquisition by EMS were associated with prolonged DTP. Impacting modifiable factors such as prehospital assessment of stroke severity is an optimal target for quality improvement.
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Affiliation(s)
- Nirav R Bhatt
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Stroke Institute, Pittsburgh, PA, USA
| | - Christian Martin-Gill
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Abdullah Al-Qudah
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Katharine Dermigny
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mohamed F Doheim
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lucas Rios Rocha
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Abdullah Sultany
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Guvanch Kakamyradov
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marcelo Rocha
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Stroke Institute, Pittsburgh, PA, USA
| | - Matthew Starr
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Stroke Institute, Pittsburgh, PA, USA
| | | | - Alhamza R Al-Bayati
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Stroke Institute, Pittsburgh, PA, USA
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Raul G Nogueira
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- UPMC Stroke Institute, Pittsburgh, PA, USA
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Ameen D, Dewey HM, Khalil H. Strategies to reduce delays in delivering mechanical thrombectomy for acute ischaemic stroke - an umbrella review. Front Neurol 2024; 15:1390482. [PMID: 38952471 PMCID: PMC11215205 DOI: 10.3389/fneur.2024.1390482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/23/2024] [Indexed: 07/03/2024] Open
Abstract
Background Mechanical thrombectomy is a time-sensitive treatment, with rapid initiation and reduced delays being associated with better patient outcomes. Several systematic reviews reported on various interventions to address delays. Hence, we performed an umbrella review of systematic reviews to summarise the current evidence. Methods Medline, Embase, Cochrane Library and JBI were searched for published systematic reviews. Systematic Reviews that detailed outcomes related to time-to-thrombectomy or functional independence were included. Methodological quality was assessed using the JBI critical appraisal tool by two independent reviewers. Results A total of 17 systematic reviews were included in the review. These were all assessed as high-quality reviews. A total of 13 reviews reported on functional outcomes, and 12 reviews reported on time-to-thrombectomy outcomes. Various interventions were identified as beneficial. The most frequently reported beneficial interventions that improved functional and time-related outcomes included: direct-to-angio-suite and using a mothership model (compared to drip-and-ship). Only a few studies investigated other strategies including other pre-hospital and teamwork strategies. Conclusion Overall, there were various strategies that can be used to reduce delays in the delivery of mechanical thrombectomy with different effectiveness. The mothership model appears to be superior to the drip-and-ship model in reducing delays and improving functional outcomes. Additionally, the direct-to-angiosuite approach appears to be beneficial, but further research is required for broader implementation of this approach and to determine which groups of patients would benefit the most.
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Affiliation(s)
- D. Ameen
- Faculty of Medicine, Nursing and Health Sciences, School of Medicine, Monash University, Clayton, VIC, Australia
| | - H. M. Dewey
- Department of Neurosciences, Eastern Health and Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - H. Khalil
- Department of Public Health, School of Psychology and Public Health, Latrobe University, Bundoora, VIC, Australia
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Flores A, Garcia-Tornel A, Seró L, Ustrell X, Requena M, Pellisé A, Rodriguez P, Monterde A, Lara L, Gonzalez-de-Echavarri JM, Molina CA, Doncel-Moriano A, Dorado L, Cardona P, Cánovas D, Krupinski J, Más N, Purroy F, Zaragoza-Brunet J, Palomeras E, Cocho D, Garcia J, Colom C, Silva Y, Gomez-Cocho M, Jiménez X, Ros-Roig J, Abilleira S, Pérez de la Ossa N, Ribo M. Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis. J Neurointerv Surg 2024; 16:143-150. [PMID: 37068936 DOI: 10.1136/jnis-2023-020125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/26/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The influence of vascular imaging acquisition on workflows at local stroke centers (LSCs) not capable of performing thrombectomy in patients with a suspected large vessel occlusion (LVO) stroke remains uncertain. We analyzed the impact of performing vascular imaging (VI+) or not (VI- at LSC arrival on variables related to workflows using data from the RACECAT Trial. OBJECTIVE To compare workflows at the LSC among patients enrolled in the RACECAT Trial with or without VI acquisition. METHODS We included patients with a diagnosis of ischemic stroke who were enrolled in the RACECAT Trial, a cluster-randomized trial that compared drip-n-ship versus mothership triage paradigms in patients with suspected acute LVO stroke allocated at the LSC. Outcome measures included time metrics related to workflows and the rate of interhospital transfers and thrombectomy among transferred patients. RESULTS Among 467 patients allocated to a LSC, vascular imaging was acquired in 277 patients (59%), of whom 198 (71%) had a LVO. As compared with patients without vascular imaging, patients in the VI+ group were transferred less frequently as thrombectomy candidates to a thrombectomy-capable center (58% vs 74%, P=0.004), without significant differences in door-indoor-out time at the LSC (median minutes, VI+ 78 (IQR 69-96) vs VI- 76 (IQR 59-98), P=0.6). Among transferred patients, the VI+ group had higher rate of thrombectomy (69% vs 55%, P=0.016) and shorter door to puncture time (median minutes, VI+ 41 (IQR 26-53) vs VI- 54 (IQR 40-70), P<0.001). CONCLUSION Among patients with a suspected LVO stroke initially evaluated at a LSC, vascular imaging acquisition might improve workflow times at thrombectomy-capable centers and reduce the rate of futile interhospital transfers. These results deserve further evaluation and should be replicated in other settings and geographies.
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Affiliation(s)
- Alan Flores
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | | | - Laia Seró
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Xavier Ustrell
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Manuel Requena
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Anna Pellisé
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Paula Rodriguez
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Angela Monterde
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Lidia Lara
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Jose María Gonzalez-de-Echavarri
- Stroke Unit, Neurology Department, Hospital Universitari de Tarragona Joan XXIII. Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain
| | - Carlos A Molina
- Stroke Unit, Department of Neurology, Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Doncel-Moriano
- Stroke Unit, Department of Neurology, Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Laura Dorado
- Stroke Unit, Department of Neurology, Hospital Germans Trias i Pujol, Badalona, Catalunya, Spain
| | - Pedro Cardona
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Catalunya, Spain
| | - David Cánovas
- Department of Neurology, Consorci Sanitari Parc Taulí, Barcelona, Spain
| | | | - Natalia Más
- Department of Neurology, Hospital Althaia, Manresa, Manresa, Catalunya, Spain
| | | | - Jose Zaragoza-Brunet
- Stroke Unit, Department of Neurology, Hospital Verge de la Cinta, Tortosa, Catalunya, Spain
| | - Ernesto Palomeras
- Department of Neurology, Hospital de Mataró, Mataro, Catalunya, Spain
| | - Dolores Cocho
- Department of Neurology, Hospital General de Granollers, Granollers, Catalunya, Spain
| | - Jessica Garcia
- Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedes, Catalunya, Spain
| | - Carla Colom
- Department of Neurology, Hospital Universitario de Igualada, Igualada, Catalunya, Spain
| | - Yolanda Silva
- Neurology Department, Stroke Unit, Doctor Josep Trueta University Hospital of Girona, Girona, Catalunya, Spain
| | - Manuel Gomez-Cocho
- Department of Neurology, Hospital de Sant Joan Despi Moises Broggi, Sant Joan Despi, Spain
| | - Xavier Jiménez
- Emergency Medical Services of Catalonia, Barcelona, Spain
| | - Josep Ros-Roig
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Sonia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain
| | - Natalia Pérez de la Ossa
- Department of Neurology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalunya, Spain
- Catalan Stroke Program, Barcelona, Spain
| | - Marc Ribo
- Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
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Radu RA, Gascou G, Machi P, Capirossi C, Costalat V, Cagnazzo F. Current and future trends in acute ischemic stroke treatment: direct-to-angiography suite, middle vessel occlusion, large core, and minor strokes. Eur J Radiol Open 2023; 11:100536. [PMID: 37964786 PMCID: PMC10641156 DOI: 10.1016/j.ejro.2023.100536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/18/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023] Open
Abstract
Since the publication of the landmark thrombectomy trials in 2015, the field of endovascular therapy for ischemic stroke has been rapidly growing. The very low number needed to treat to provide functional benefits shown by the initial randomized trials has led clinicians and investigators to seek to translate the benefits of endovascular therapy to other patient subgroups. Even if the treatment effect is diminished, currently available data has provided sufficient information to extend endovascular therapy to large infarct core patients. Recently, published data have also shown that sophisticated imaging is not necessary for late time- window patients. As a result, further research into patient selection and the stroke pathway now focuses on dramatically reducing door-to-groin times and improving outcomes by circumventing classical imaging paradigms altogether and employing a direct-to-angio suite approach for selected large vessel occlusion patients in the early time window. While the results of this approach mainly concern patients with severe deficits, there are further struggles to provide evidence of the efficacy and safety of endovascular treatment in minor stroke and large vessel occlusion, as well as in patients with middle vessel occlusions. The current lack of good quality data regarding these patients provides significant challenges for accurately selecting potential candidates for endovascular treatment. However, current and future randomized trials will probably elucidate the efficacy of endovascular treatment in these patient populations.
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Affiliation(s)
- Răzvan Alexandru Radu
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Stroke Unit, Department of Neurology, University Emergency Hospital Bucharest, Bucharest, Romania
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Gregory Gascou
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Paolo Machi
- Department of Neuroradiology, University of Geneva Medical Center, Switzerland
| | - Carolina Capirossi
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
- Department of Neurointerventional Radiology, Careggi Hospital, Florence, Italy
| | - Vincent Costalat
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
| | - Federico Cagnazzo
- Department of Neuroradiology, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France
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Molad J, Honig A. Current advances in endovascular treatment. Curr Opin Neurol 2023; 36:125-130. [PMID: 36762653 DOI: 10.1097/wco.0000000000001142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
PURPOSE OF REVIEW Endovascular thrombectomy (EVT) is the most beneficial reperfusion therapy for acute ischemic stroke. Currently, much effort is done to promote trials examining EVT efficacy and safety in various conditions not included in the main randomized controlled trials established the superiority of EVT. This review summarizes the current advances of EVT patients' selection and periprocedural management. RECENT FINDINGS Recent evidence points to beneficial effect of EVT among patients with relatively large ischemic core, premorbid independent nonagenarians and basilar artery occlusion, and suggest that intravenous thrombolysis bridging treatment is associated with better reperfusion rates. Ongoing trials currently examine EVT efficacy and safety in distal vessel occlusions and in large vessel occlusion with low NIHSS. Current evidence also support use of general anaesthesia and avoid postprocedural extremely low or high blood pressure as well as haemodynamic instability. SUMMARY The field of EVT is rapidly evolving. The results of recent trials have dramatically increased the indications for EVT, with many ongoing trials examining further indications.
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Affiliation(s)
- Jeremy Molad
- Department of Stroke & Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv
| | - Asaf Honig
- Department of Neurology, Soroka Medical Center, Beer-Sheva, Israel
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