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Hou S, Zhang Y, Xia Y, Liu Y, Deng X, Wang W, Wang Y, Wang C, Wang G. Global, regional, and national epidemiology of ischemic stroke from 1990 to 2021. Eur J Neurol 2024:e16481. [PMID: 39290044 DOI: 10.1111/ene.16481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/26/2024] [Accepted: 08/28/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND AND PURPOSE This study aims to examine the global, regional, and national burden of ischemic stroke from 1990 to 2021. METHOD We used data from the Global Burden of Disease (GBD) 2021 database to comprehensively assess ischemic stroke indicators globally, regionally, and in 204 countries, including incidence, deaths, disability-adjusted life years (DALYs), estimated annual percentage change (EAPC), and Joinpoint regression analysis. RESULTS In 2021, there were a total of 7,804,449 cases of ischemic stroke globally (95% uncertainty interval = 6,719,760-8,943,692), with an age-standardized incidence rate (ASIR) of 92.39. This represents a declining trend compared to 1990, with an EAPC of -0.67 (95% confidence interval [CI] = -0.76 to -0.58). Mortality and DALY rates also showed a downward trend (EAPC in age-standardized mortality rate: -1.83, 95% CI = -1.92 to -1.74; EAPC in age-standardized DALY rate = -1.59, 95% CI = -1.68 to -1.50). The burden of ischemic stroke was inversely correlated with gross domestic product. Regionally, from 2014 to 2021, the Caribbean experienced the fastest increase in ASIR (annual percent change = 0.15, 95% CI = 0.13 to 0.18). Among 204 countries, North Macedonia had the highest incidence, mortality, and DALY rates. In addition to metabolic risks, particulate matter pollution and low temperatures were significant environmental and occupational risk factors for ischemic stroke. Smoking and a diet high in sodium were identified as key behavioral risk factors. CONCLUSIONS Ischemic stroke remains a serious global health challenge, and our results from this cross-sectional study suggest that the burden of disease remains high in Eastern Europe, East Asia, Central Asia, and Sub-Saharan Africa.
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Affiliation(s)
- Shuai Hou
- Emergency Department, Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Yifeng Zhang
- Department II of Neurology, Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Yulei Xia
- Department II of Neurology, Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Yong Liu
- Emergency Department, Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Xia Deng
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Weihua Wang
- Emergency Department, Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Yanqiang Wang
- Department II of Neurology, Affiliated Hospital of Shandong Second Medical University, Weifang, China
| | - Chunping Wang
- School of Public Health, Shandong Second Medical University, Weifang, China
| | - Gang Wang
- Emergency Department, Affiliated Hospital of Shandong Second Medical University, Weifang, China
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2
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Raychev R, Sun JL, Schwamm L, Smith EE, Fonarow GC, Messé SR, Xian Y, Chiswell K, Blanco R, Mac Grory B, Saver JL. Performance of Thrombectomy-Capable, Comprehensive, and Primary Stroke Centers in Reperfusion Therapies for Acute Ischemic Stroke: Report From the Get With The Guidelines-Stroke Registry. Circulation 2023; 148:2019-2028. [PMID: 37855118 DOI: 10.1161/circulationaha.123.066114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND The thrombectomy-capable stroke center (TSC) is a recently introduced intermediate tier of accreditation for hospitals at which patients with acute ischemic stroke receive care. The comparative quality and clinical outcomes of reperfusion therapies at TSCs, primary stroke centers (PSCs), and comprehensive stroke centers (CSCs) have not been well delineated. METHODS We conducted a retrospective, observational, cohort study from 2018 to 2020 that included patients with acute ischemic stroke who received endovascular thrombectomy (EVT) and intravenous thrombolysis reperfusion therapies at CSCs, TSCs, or PSCs. Participants were recruited from Get With The Guidelines-Stroke registry. Study end points included timeliness of intravenous thrombolysis and EVT, successful reperfusion, discharge destination, discharge mortality, and functional independence at discharge. RESULTS Among 84 903 patients, 48 682 received EVT, of whom 73% were treated at CSCs, 22% at PSCs, and 4% at TSCs. The median annual EVT volume was 76 for CSCs, 55 for TSCs, and 32 for PSCs. Patient differences by center status included higher National Institutes of Health Stroke Scale score, longer onset-to-arrival time, and higher transfer-in rates for CSCs, TSCs, and PSCs, respectively. In adjusted analyses, the likelihood of achieving the goal door-to-needle time was higher in CSCs compared with PSCs (odds ratio [OR], 1.39 [95% CI, 1.17-1.66]) and in TSCs compared with PSCs (OR, 1.45 [95% CI, 1.08-1.96]). Likewise, the odds of achieving the goal door-to-puncture time were higher in CSCs compared with PSCs (OR, 1.58 [95% CI, 1.13-2.21]). CSCs and TSCs also demonstrated better clinical efficacy outcomes compared with PSCs. The odds of discharge to home or rehabilitation were higher in CSCs compared with PSCs (OR, 1.18 [95% CI, 1.06-1.31]), whereas the odds of in-hospital mortality or discharge to hospice were lower in both CSCs compared with PSCs (OR, 0.87 [95% CI, 0.81-0.94]) and TSCs compared with PSCs (OR, 0.86 [95% CI, 0.75-0.98]). There were no significant differences in any of the quality-of-care metrics and clinical outcomes between TSCs and CSCs. CONCLUSIONS In this study representing national US practice, CSCs and TSCs exceeded PSCs in key quality-of-care reperfusion metrics and outcomes, whereas TSCs and CSCs demonstrated a similar performance. With more than one-fifth of all EVT procedures during the study period conducted at PSCs, it may be desirable to explore national initiatives aimed at facilitating the elevation of eligible PSCs to a higher certification status.
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Affiliation(s)
- Radoslav Raychev
- Duke Clinical Research Institute, Durham, NC (J.-L.S., K.C., R.R.)
- Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA (R.R., J.S., G.C.F.)
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Durham, NC (J.-L.S., K.C., R.R.)
- Duke University School of Medicine, Durham, NC (J.-L.S.)
| | - Lee Schwamm
- Yale School of Medicine, New Haven, CT (L.S.)
| | | | - Gregg C Fonarow
- Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA (R.R., J.S., G.C.F.)
| | | | - Ying Xian
- University of Texas, Southwestern Medical Center, Dallas (Y.X.)
| | - Karen Chiswell
- Duke Clinical Research Institute, Durham, NC (J.-L.S., K.C., R.R.)
| | | | | | - Jeffrey L Saver
- Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA (R.R., J.S., G.C.F.)
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3
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Calixte A, Lartigue S, McGaugh S, Mathelier M, Patel A, Siyanaki MRH, Pierre K, Lucke-Wold B. Neurointerventional Radiology: History, Present and Future. JOURNAL OF RADIOLOGY AND ONCOLOGY 2023; 7:26-32. [PMID: 37795208 PMCID: PMC10550195 DOI: 10.29328/journal.jro.1001049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Neurointerventional Radiology (NIR), encompassing neuroendovascular surgery, endovascular neurosurgery, and interventional neurology, is an innovative and rapidly evolving multidisciplinary specialty focused on minimally invasive therapies for a wide range of neurological disorders. This review provides a comprehensive overview of NIR, discussing the three routes into the field, highlighting their distinct training paradigms, and emphasizing the importance of unified approaches through organizations like the Society of Neurointerventional Surgery (SNIS). The paper explores the benefits of co-managed care and its potential to improve patient outcomes, as well as the role of interdisciplinary collaboration and cross-disciplinary integration in advancing the field. We discuss the various contributions of neurosurgery, radiology, and neurology to cerebrovascular surgery, aiming to inform and educate those interested in pursuing a career in neurointervention. Additionally, the review examines the adoption of innovative technologies such as robotic-assisted techniques and artificial intelligence in NIR, and their implications for patient care and the future of the specialty. By presenting a comprehensive analysis of the field of neurointervention, we hope to inspire those considering a career in this exciting and rapidly advancing specialty, and underscore the importance of interdisciplinary collaboration in shaping its future.
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Affiliation(s)
- Andre Calixte
- New York Medical College, Valhalla, New York, 10595, USA
| | - Schan Lartigue
- New York Medical College, Valhalla, New York, 10595, USA
| | - Scott McGaugh
- University of Florida College of Medicine, Gainesville, Florida, 32608, USA
| | - Michael Mathelier
- University of Florida College of Medicine, Gainesville, Florida, 32608, USA
| | - Anjali Patel
- University of Florida College of Medicine, Gainesville, Florida, 32608, USA
| | | | - Kevin Pierre
- University of Florida Department of Radiology, Gainesville, Florida, 32608, USA
| | - Brandon Lucke-Wold
- University of Florida Department of Neurosurgery, Gainesville, Florida, 32608, USA
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4
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Brisson RT, Fernandes RDCL, Arruda JFDL, Rocha TCCDSM, Santos NDGD, Silva LD, de Lima MASD, de Rosso ALZ. Altered Cerebral Vasoreactivity on Transcranial Color-Coded Sonography Related to Akinetic-Rigid Phenotype of Parkinson's Disease: Interim Analysis of a Cross-Sectional Study. Brain Sci 2023; 13:brainsci13050709. [PMID: 37239181 DOI: 10.3390/brainsci13050709] [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: 03/18/2023] [Revised: 04/13/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND A correlation between worse functional outcomes in Parkinson's disease (PD) patients with cerebrovascular disease (CVD) or the Akinetic-rigid phenotype has been argued in recent studies. We aimed to evaluate the association of cerebral hemodynamics impairments, assessed by Transcranial Color-coded Doppler sonography (TCCS), on PD patients with different phenotypes of the disease and with risk factors for CVD. METHODOLOGY Idiopathic PD patients (n = 51) were divided into motor subtypes: Akinetic-rigid (AR) (n = 27) and Tremor-dominant (TD) (n = 24) and into two groups regarding vascular risk factors: when ≥2 were present (PDvasc) (n = 18) and <2 (PDnvasc) (n = 33). In a parallel analysis, the Fazekas scale on brain magnetic resonance imaging (MRI) was applied to a sample to assess the degree of leukoaraiosis. TCCS examinations were prospectively performed obtaining middle cerebral artery Mean Flow Velocities (Vm), Resistance Index (RI), and Pulsatility Index (PI). The Breath-Holding Index (BHI) was calculated to assess cerebrovascular reactivity (cVR). Standardized functional scales were administered (UPDRS III and Hoehn&Yahr). RESULTS The phenotype groups were similar in age, disease duration and demographic parameters, but there were significantly higher H&Y scores than TD group. cVR was impaired in 66.7% of AR vs. 37.5% of TD. AR group exhibited lower BHI (0.53 ± 0.31 vs. 0.91 ± 0.62; p = 0.000), lower Vm after apnea (44.3 ± 9.0 cm/s vs. 53.4 ± 11.4 cm/s; p = 0.003), higher PI (0.91 ± 0.26 vs. 0.76 ± 0.12; p = 0.000) and RI (0.58 ± 0.11 vs. 0.52 ± 0.06; p = 0.021). PDvasc group showed higher PI (0.98 vs. 0.76; p = 0.001) and higher frequency of altered cVR (72.2% vs. 42.2%; p = 0.004). There was a significant predominance of higher values on Fazekas scale in the PDvasc group. We found no difference between the Fazekas scale when comparing motor subtypes groups but there was a trend toward higher scores in the AR phenotype. CONCLUSIONS TCCS, a cost-effective method, displayed impaired cVR in Parkinsonian patients with risk factors for CVD with higher degree of MRI leukoaraiosis. PD patients with the AR disease phenotype also presented impaired cVR on TCCS and greater functional impairment, although with just a trend to higher scores on MRI Fazekas.
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Affiliation(s)
- Rodrigo Tavares Brisson
- Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Rita de Cássia Leite Fernandes
- Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Josevânia Fulgêncio de Lima Arruda
- Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | | | - Nathália de Góes Duarte Santos
- Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Liene Duarte Silva
- Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Marco Antônio Sales Dantas de Lima
- Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
| | - Ana Lucia Zuma de Rosso
- Department of Neurology, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-617, Brazil
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Waqas M, Tutino VM, Cappuzzo JM, Lazarov V, Popoola D, Patel TR, Levy BR, Monteiro A, Mokin M, Rai AT, Mocco J, Turk AS, Snyder KV, Davies JM, Levy EI, Siddiqui AH. Stroke thrombectomy volume, rather than stroke center accreditation status of hospitals, is associated with mortality and discharge disposition. J Neurointerv Surg 2023; 15:209-213. [PMID: 35232752 DOI: 10.1136/neurintsurg-2021-018079] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few studies have explored the association between stroke thrombectomy (ST) volume and hospital accreditation with clinical outcomes. OBJECTIVE To assess the association of ST case volume and accreditation status with in-hospital mortality and home discharge disposition using the national Medicare Provider Analysis and Review (MEDPAR) database. METHODS Rates of hospital mortality, home discharge disposition, and hospital stay were compared between accredited and non-accredited hospitals using 2017-2018 MEDPAR data. The association of annual ST case volume with mortality and home disposition was determined using Pearson's correlation. Median rate of mortality and number of ST cases at hospitals within the central quartiles were estimated. RESULTS A total of 29 355 cases were performed over 2 years at 847 US centers. Of these, 354 were accredited. There were no significant differences between accredited and non-accredited centers for hospital mortality (14.8% vs 14.5%, p=0.34) and home discharge (12.1% vs 12.0%, p=0.78). A significant positive correlation was observed between thrombectomy volume and home discharge (r=0.88; 95% CI 0.58 to 0.97, p=0.001). A significant negative relationship was found between thrombectomy volume and mortality (r=-0.86; 95% CI -0.97 to -0.49, p=0.002). Within the central quartiles, the median number of ST cases at hospitals with mortality was 24/year, and the median number of ST cases at hospitals with home discharge rate was 23/year. CONCLUSION A higher volume of ST cases was associated with lower mortality and higher home discharge rate. No significant differences in mortality and discharge disposition were found between accredited and non-accredited hospitals.
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Affiliation(s)
- Muhammad Waqas
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Vincent M Tutino
- Department of Neurosurgery, Pathology and Anatomical Sciences, and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Victoria Lazarov
- Medical Student, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Daniel Popoola
- Medical Student, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Tatsat R Patel
- Department of Biomedical Engineering, University at Buffalo, Buffalo, New York, USA
| | - Bennett R Levy
- Medical Student, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Andre Monteiro
- Department of Neurosurgery, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
| | - Maxim Mokin
- Department of Neurosurgery and Brain Repair, University of South Florida, Tampa, Florida, USA.,Neurosciences Center, Tampa General Hospital, Tampa, Florida, USA
| | - Ansaar T Rai
- Department of Interventional Neuroradiology, West Virginia University Rockefeller Neuroscience Institute, Morgantown, West Virginia, USA
| | - J Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aquilla S Turk
- Department of Neurosurgery, Prisma Health Upstate, Greenville, South Carolina, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Department of Neurosurgery and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Department of Neurosurgery and Bioinformatics and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA.,Department of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA .,Department of Neurosurgery and Radiology and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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6
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Sacks D, Dhand S, Hegg R, Hirsch K, McCollom V, Sarin S, Vadlamudi V, Wasser T, Zylak C. Outcomes of Stroke Thrombectomy Performed by Interventional Radiologists vs Neurointerventional Physicians. J Vasc Interv Radiol 2022; 33:619-626.e1. [PMID: 35150837 DOI: 10.1016/j.jvir.2021.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/04/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To test the hypothesis that interventional radiologists (IR) have outcomes for endovascular stroke thrombectomy (EVT) similar to Neurointerventional (NI) physicians and could be used to improve availability of thrombectomy. MATERIALS AND METHODS Eight hospitals providing EVT performed by IR and NI in the same institution submitted sequential retrospective data limited to the era of modern devices. Good clinical outcome (90 day modified Rankin score 0-2) and successful revascularization (modified Thrombolysis in Cerebral Infarction score > 2b) were compared between specialties, adjusted for treating hospital, patient age, stroke severity, Alberta Stroke Program Early CT Score (ASPECTS), time from symptom onset to door, and clot location. Propensity score matching was used to compare outcomes. A total of 1009 patients were entered (622 treated by IR and 387 treated by NI). RESULTS Median stroke onset to puncture was 245 vs 253 minutes (p=.49), technically successful revascularization was 81.8% vs 82.4% (p=.81), and good clinical outcome was 45.5% vs 50.1% (p=.16), respectively. After adjusting, physician specialty was not a significant predictor of good clinical outcome (odds ratio 1.028 [95% CI 0.760-1.390]; p=.86). After matching, mRS 0-2 was 47.7% for IR and 51.1% for NI (p=0.366). CONCLUSION There was no significant difference in successful revascularization and good clinical outcomes between IR and NI physicians. Outcomes by IR were similar to NI outcomes from previously published trials and registries. This may be useful to address coverage and access to stroke interventions.
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Affiliation(s)
| | | | - Ryan Hegg
- Research Medical Center, Kansas City, MO
| | | | | | - Shawn Sarin
- George Washington University Hospital, Washington, DC
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7
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Czap AL, Harmel P, Audebert H, Grotta JC. Stroke Systems of Care and Impact on Acute Stroke Treatment. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00051-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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8
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Londhe SR, Gg SK, Keshava SN, Mohan C. Indian College of Radiology and Imaging (ICRI) Consensus Guidelines for the Early Management of Patients with Acute Ischemic Stroke: Imaging and Intervention. Indian J Radiol Imaging 2021; 31:400-408. [PMID: 34556925 PMCID: PMC8448212 DOI: 10.1055/s-0041-1734346] [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] [Indexed: 11/26/2022] Open
Abstract
The medical science has witnessed significant change in the management of acute stroke patients as a result of recent advances in the field of stroke imaging and endovascular mechanical thrombectomy in addition to intravenous thrombolysis and optimization of stroke services in balance with available resources. Despite initial negative trials, we witnessed the publication of five multicenter randomized clinical trials showing superiority of the endovascular approach over standard medical management in patients with large vessel occlusion. The aim of this study is to provide comprehensive set of evidence-based recommendations regarding imaging and endovascular interventions in acute ischemic stroke patients.
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Affiliation(s)
- Shrikant R Londhe
- Department of Interventional Neuroradiology, Noble Hospital, Pune, Maharashtra, India
| | - Sharath Kumar Gg
- Department of Diagnostic and Interventional Neuroradiology, Apollo Hospitals, Bangalore, Karnataka, India
| | - Shyamkumar N Keshava
- Department of Interventional Radiology, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India
| | - Chander Mohan
- Interventional Radiology, ICRI Director, Interventional Radiology, BLK Super Specialty Hospital, Pusa Road, New Delhi, India
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9
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Shlobin NA, Levy EI. Engaging Medical Students in Neurointervention: Rationale and Recruitment. World Neurosurg 2021; 154:80-82. [PMID: 34332150 DOI: 10.1016/j.wneu.2021.07.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elad I Levy
- Departments of Neurosurgery and Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Canon Stroke and Vascular Research Center, University at Buffalo, Jacobs Institute, Buffalo, New York, USA.
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10
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Stable Clinical Outcomes When a Stroke Thrombectomy Program Is Started in an Experienced Cardiology Cath Lab. JACC Cardiovasc Interv 2021; 14:785-792. [PMID: 33826499 DOI: 10.1016/j.jcin.2021.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study analyzed the learning curve effect when a new stroke thrombectomy program was initiated in a cardiac cath lab in close cooperation with neurologists and radiologists. BACKGROUND Mechanical thrombectomy has proven to be the best treatment option for ischemic stroke patients, but this method is not widely available. METHODS An endovascular treatment program for acute ischemic strokes was established in the cardiac cath lab of a tertiary university hospital in 2012. The decision to perform catheter-based thrombectomy was made by a neurologist and was based on acute stroke clinical symptoms and computed tomography angiographic findings. Patients with a large vessel occlusion of either anterior or posterior circulation were enrolled. The primary endpoint was the functional neurological outcome (Modified Rankin Scale [mRS] score) of the patient at 3 months. A total of 333 patients were enrolled between October 2012 and December 2019. RESULTS The clinical (mRS) outcomes did not vary significantly across years 2012 to 2019 (mRS 0 to 2 was achieved in 47.9% of patients). Symptomatic intracerebral hemorrhage occurred in 19 patients (5.7%). Embolization in a new vascular territory occurred in 6 patients (1.8%). CONCLUSIONS When a catheter-based thrombectomy program was initiated in an experienced cardiac cath lab in close cooperation between cardiologists, neurologists, and radiologists, outcomes were comparable to those of neuroradiology centers. The desired clinical results were achieved from the onset of the program, without any signs of a learning curve effect. These findings support the potential role of interventional cardiac cath labs in the treatment of acute stroke in regions where this therapy is not readily available due to the lack of neurointerventionalists.
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11
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Casolla B, de Leciñana MA, Neves R, Pfeilschifter W, Svobodova V, Jung S, Kemmling A, Mikulik R, Santalucia P. Simulation training programs for acute stroke care: Objectives and standards of methodology. Eur Stroke J 2021; 5:328-335. [PMID: 33598550 DOI: 10.1177/2396987320971105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/09/2020] [Indexed: 01/22/2023] Open
Abstract
The European Stroke Organisation (ESO) Simulation Committee was established in 2017 with the intent to promote simulation education and training in the stroke field. The application of simulation methodology in education and training improves healthcare professional performances in real clinical practice and patient outcomes. We evaluated the implementation of simulation training in stroke medicine, how it can significantly affect stroke pathways and quality of care. We herewith describe simulation techniques in the acute stroke setting. Simulation programs place the trainees in a safe environment, allowing both role-playings for decision making training and procedural simulation for technical skills improvement. This paper includes the position of the Committee on the key points, principles, and steps in order to set up and promote simulation programs in European stroke centers. Stroke is an emergency, and hyperacute phase management requires knowledge, expertise, optimal multidisciplinary team working, and timely actions in a very narrow time window. The ESO Simulation Committee promotes the implementation of simulation training in stroke care according to a specific and validated methodology.
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Affiliation(s)
- Barbara Casolla
- Department of Neurology, Stroke Unit, Univ. Lille, Inserm U1172, CHU Lille, Lille, France
| | - Maria Alonso de Leciñana
- Department of Neurology, Stroke Center, University Hospital La Paz, Universidad Autónoma, Madrid, Spain
| | - Raquel Neves
- Royal Heath Group Czech Rehabilitation Hospital, Abu Dhabi, United Arab Emirates
| | - Waltraud Pfeilschifter
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Veronica Svobodova
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Simon Jung
- Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - André Kemmling
- Department of Neuroradiology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.,Neurology Department, St. Anne's University Hospital and Masaryk University, Brno, Czech Republic
| | - Paola Santalucia
- Department of Neurology and Strategic Direction, Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
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Ernst E, Papanagiotou P, Politi M, Alexandrou M, Kastrup A, Boutchakova M, Roth C. Safety and effectiveness of CATCH+ as a first-line device for revascularization in the treatment of acute ischemic stroke. J Neuroradiol 2021; 48:5-9. [DOI: 10.1016/j.neurad.2019.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/01/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
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13
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Schreier DR, Di Lorenzo F, Iodice F, Shribman S. Do you want to perform endovascular therapy? Perspectives from neurology trainees across Europe. Eur J Neurol 2020; 27:2646-2650. [PMID: 32918361 DOI: 10.1111/ene.14519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/31/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Endovascular therapy (EVT) has become standard care for acute ischaemic stroke caused by large-vessel occlusion in the anterior circulation. However, access to this treatment in Europe remains poor. The lack of operators is a contributing factor and there is on-going discussion as to whether other specialists, including neurologists, could contribute to the EVT workforce. The question remains whether the next generation of neurologists want to become 'interventional neurologists'. The aim of this study was to address this question. METHODS We conducted a short survey within the National Representatives Network (a division of the Resident and Research Fellow Section, European Academy of Neurology) in order to determine the interest of future neurologists in performing EVT. RESULTS A total of 1218 responses from 27 European countries were received, with some variation in the number of respondents and results among individual countries. In total, 568 neurology trainees (47%) stated that they would want to be an 'interventional neurologist'. CONCLUSION Our findings suggest that neurologists could make a significant contribution to the workforce performing EVT and have important implications for the development and uptake of training programmes in Europe.
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Affiliation(s)
- D R Schreier
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Di Lorenzo
- Non Invasive Brain Stimulation Unit, Department of Behavioral and Clinical Neurology, Santa Lucia Foundation IRCCS, Rome, Italy
| | - F Iodice
- Institute of Neurology, Catholic University of the Sacred Heart, Fondazione Policlinico Gemelli IRCCS, Rome, Italy
| | - S Shribman
- Reta Lila Weston Institute of Neurological Studies, UCL Queen Square Institute of Neurology, London, UK
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Guenego A, Mosimann PJ, Wintermark M, Heit JJ, Zuber K, Dobrocky T, Lotterie JA, Nicholson P, Marcellus DG, Olivot JM, Gonzalez N, Blanc R, Pereira VM, Gralla J, Kaesmacher J, Fahed R, Piotin M, Cognard C. Safety and Effectiveness of Neuro-thrombectomy on Single compared to Biplane Angiography Systems. Sci Rep 2020; 10:4470. [PMID: 32161286 PMCID: PMC7066129 DOI: 10.1038/s41598-020-60851-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 02/14/2020] [Indexed: 12/11/2022] Open
Abstract
An increasing number of centers not necessarily equipped with biplane (BP) angiosuites are performing mechanical thrombectomy (MT) in acute ischemic stroke patients. We assessed whether MT performed on single-plane (SP) is equivalent in terms of safety, effectiveness, radiation and contrast agent exposure. Consecutive patients treated by MT in four high volume centers between January 2014 and May 2017 were included. Demographic and MT characteristics were assessed and compared between SP and BP. Of 906 patients treated by MT, 576 (64%) were handled on a BP system. After multivariate analysis, contrast load and fluoroscopy duration were significantly lower in the BP group [100vs200mL, relative effect 0.85 (CI: 0.79-0.92), p = 0.0002; 22 vs 27 min, relative effect 0.84 (CI: 0.76-0.93), p = 0.0008, respectively]. There was no difference in recanalization (modified Thrombolysis-In-Cerebral-Infarction 2b-3), good clinical outcome (modified Rankin Scale 0-2), complications rates, procedure duration or radiation exposure. A three-vessel diagnostic angiogram performed prior to MT led to a significant increase in procedure duration (15% increase, p = 0.05), radiation exposure (33% increase, p < 0.0001) and contrast load (125% increase, p < 0.0001). Mechanical neuro-thrombectomy seems equally safe and effective on a single or biplane angiography system despite increased contrast load and fluoroscopy duration on the former.
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Affiliation(s)
- Adrien Guenego
- Interventional and Diagnostic Neuroradiology Department, Toulouse University Hospital, Toulouse, France.
| | | | - Max Wintermark
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Jeremy J Heit
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Kevin Zuber
- Statistics department, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Tomas Dobrocky
- Interventional and diagnostic Neuroradiology, Bern, Switzerland
| | - Jean Albert Lotterie
- Stereotaxic Neurosurgery Department, Toulouse University Hospital, Toulouse, France
| | - Patrick Nicholson
- Interventional and Diagnostic Neuroradiology, Toronto Hospital, Toronto, Canada
| | - David G Marcellus
- Interventional and Diagnostic Neuroradiology, Stanford Medical Center, California, USA
| | - Jean Marc Olivot
- Vascular Neurology, Stroke Department, Toulouse University Hospital, Toulouse, France
| | - Nestor Gonzalez
- Neurosurgery and Interventional Neuroradiology Department, Cedars Sinai Hospital, Los Angeles, USA
| | - Raphaël Blanc
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Jan Gralla
- Interventional and diagnostic Neuroradiology, Bern, Switzerland
| | | | - Robert Fahed
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | - Christophe Cognard
- Interventional and Diagnostic Neuroradiology Department, Toulouse University Hospital, Toulouse, France
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15
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Sasiadek M, Kocer N, Szikora I, Vilela P, Muto M, Jansen O, Causin F, Cognard C, White P, Brouwer P, Pizzini F, Schroth G, Ricci P. Standards for European training requirements in interventional neuroradiology guidelines by the Division of Neuroradiology/Section of Radiology European Union of Medical Specialists (UEMS), in cooperation with the Division of Interventional Radiology/UEMS, the European Society of Neuroradiology (ESNR), and the European Society of Minimally Invasive Neurological Therapy (ESMINT). J Neurointerv Surg 2019; 12:326-331. [DOI: 10.1136/neurintsurg-2019-015537] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 11/03/2022]
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16
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Weyland CS, Hemmerich F, Möhlenbruch MA, Bendszus M, Pfaff JAR. Radiation exposure and fluoroscopy time in mechanical thrombectomy of anterior circulation ischemic stroke depending on the interventionalist’s experience—a retrospective single center experience. Eur Radiol 2019; 30:1564-1570. [DOI: 10.1007/s00330-019-06482-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/10/2019] [Accepted: 10/09/2019] [Indexed: 12/21/2022]
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17
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Sacks D, AbuAwad MK, Ahn SH, Baerlocher MO, Brady PS, Cole JW, Dhand S, Fox BD, Gemmete JJ, Kee-Sampson JW, McCollom V, Patel PJ, Radvany MG, Tomalty RD, Vadlamudi V, Webb MS, Wojak JC. Society of Interventional Radiology Training Guidelines for Endovascular Stroke Treatment. J Vasc Interv Radiol 2019; 30:1523-1531. [DOI: 10.1016/j.jvir.2019.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 01/19/2023] Open
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18
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Schirmer CM, Siddiqui AH, Frid I, Khalessi AA, Mocco J, Griessenauer CJ, Goren O, Dalal S, Weiner G, Arthur AS. Modern Training and Credentialing in Neuroendovascular Acute Ischemic Stroke Therapy. Neurosurgery 2019; 85:S52-S57. [DOI: 10.1093/neuros/nyz014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/23/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania
| | - Adnan H Siddiqui
- Toshiba Stroke and Vascular Research Center, Department of Neurosurgery, Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York
| | - Ilya Frid
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
| | - Alexander A Khalessi
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California
| | - J Mocco
- Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Christoph J Griessenauer
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania
- Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Oded Goren
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania
| | - Shamsher Dalal
- Department of Radiology, Geisinger, Danville, Pennsylvania
| | - Gregory Weiner
- Department of Neurosurgery and Neuroscience Institute, Geisinger, Danville, Pennsylvania
| | - Adam S Arthur
- Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis, Tennessee
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19
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Shah S, Xian Y, Sheng S, Zachrison KS, Saver JL, Sheth KN, Fonarow GC, Schwamm LH, Smith EE. Use, Temporal Trends, and Outcomes of Endovascular Therapy After Interhospital Transfer in the United States. Circulation 2019; 139:1568-1577. [PMID: 30700144 PMCID: PMC6816244 DOI: 10.1161/circulationaha.118.036509] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 01/08/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The use of endovascular therapy (EVT) in patients with acute ischemic stroke who have large vessel occlusion has rapidly increased in the United States following pivotal trials demonstrating its benefit. Information about the contribution of interhospital transfer in improving access to EVT will help organize regional systems of stroke care. METHODS We analyzed trends of transfer-in EVT from a cohort of 1 863 693 patients with ischemic stroke admitted to 2143 Get With The Guidelines-Stroke participating hospitals between January 2012 and December 2017. We further examined the association between arrival mode and in-hospital outcomes by using multivariable logistic regression models. RESULTS Of the 37 260 patients who received EVT at 639 hospitals during the study period, 42.9% (15 975) arrived at the EVT-providing hospital after interhospital transfer. Transfer-in EVT cases increased from 256 in the first quarter 2012 to 1422 in the fourth quarter 2017, with sharply accelerated increases following the fourth quarter 2014 ( P<0.001 for change in linear trend). Transfer-in patients were younger and more likely to be of white race, to arrive during off-hours, and to be treated at comprehensive stroke centers. Transfer-in patients had significantly longer last-known-well-to-EVT initiation time (median, 289 minutes versus 213 minutes; absolute standardized difference, 67.33) but were more likely to have door-to-EVT initiation time of ≤90 minutes (65.6% versus 23.6%; absolute standardized difference, 93.18). In-hospital outcomes were worse for transfer-in patients undergoing EVT in unadjusted and in risk-adjusted models. Although the difference in in-hospital mortality disappeared after adjusting for delay in EVT initiation (14.7% versus 13.4%; adjusted odds ratio, 1.01; 95% CI, 0.92-1.11), transfer-in patients were still more likely to develop symptomatic intracranial hemorrhage (7.0% versus 5.7%; adjusted odds ratio, 1.15; 95% CI, 1.02-1.29) and less likely to have either independent ambulation at discharge (33.1% versus 37.1%; adjusted odds ratio, 0.87; 95% CI, 0.80-0.95) or to be discharged to home (24.3% versus 29.1%; adjusted odds ratio, 0.82; 95% CI, 0.76-0.88). CONCLUSIONS Interhospital transfer for EVT is increasingly common and is associated with a significant delay in EVT initiation highlighting the need to develop more efficient stroke systems of care. Further evaluation to identify factors that impact EVT outcomes for transfer-in patients is warranted.
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Affiliation(s)
- Shreyansh Shah
- Department of Neurology, Duke University Hospital, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | - Ying Xian
- Department of Neurology, Duke University Hospital, Durham, NC
- Duke Clinical Research Institute, Durham, NC
| | | | - Kori S. Zachrison
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Kevin N. Sheth
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | | | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Eric E. Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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20
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Menon BK, Xu H, Cox M, Saver JL, Goyal M, Peterson E, Xian Y, Matsuoka R, Jehan R, Yavagal D, Gupta R, Mehta B, Bhatt DL, Fonarow GC, Schwamm LH, Smith EE. Components and Trends in Door to Treatment Times for Endovascular Therapy in Get With The Guidelines-Stroke Hospitals. Circulation 2019; 139:169-179. [DOI: 10.1161/circulationaha.118.036701] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Bijoy K. Menon
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (B.K.M., M.G., E.E.S.)
| | - Haolin Xu
- Duke Clinical Research Institute (H.X., M.C., E.P., Y.X.), Duke University, Durham, NC
| | - Margueritte Cox
- Duke Clinical Research Institute (H.X., M.C., E.P., Y.X.), Duke University, Durham, NC
| | - Jeffrey L. Saver
- Department of Neurology (J.L.S.), University of California, Los Angeles
| | - Mayank Goyal
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (B.K.M., M.G., E.E.S.)
| | - Eric Peterson
- Duke Clinical Research Institute (H.X., M.C., E.P., Y.X.), Duke University, Durham, NC
| | - Ying Xian
- Duke Clinical Research Institute (H.X., M.C., E.P., Y.X.), Duke University, Durham, NC
| | - Roland Matsuoka
- Departments of Biostatistics and Bioinformatics (R.M.), Duke University, Durham, NC
| | - Reza Jehan
- Departments of Neurosurgery and Radiology (R.J.), University of California, Los Angeles
| | - Dileep Yavagal
- Departments of Neurology and Neurosurgery, University of Miami Miller School of Medicine, FL (D.Y.)
| | - Rishi Gupta
- Wellstar Neuroscience Institute, Georgia Institute of Technology, Marietta (R.G.)
| | | | - Deepak L. Bhatt
- Brigham and Women’s Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C. Fonarow
- Ahmanson-University of California, Los Angeles, Cardiomyopathy Center, Ronald Reagan-University of California, Los Angeles, Medical Center (G.C.F.), University of California, Los Angeles
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.)
| | - Eric E. Smith
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Canada (B.K.M., M.G., E.E.S.)
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21
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Lauzon B, Corrigan-Lauzon C, Grynspan J, Bursey S, Krings T, Puranam P. Quantifying candidate volume for endovascular therapy for acute ischemic stroke: a retrospective chart review. CMAJ Open 2018; 6:E671-E677. [PMID: 30591545 PMCID: PMC6307980 DOI: 10.9778/cmajo.20180057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Endovascular therapy is the new standard of care for certain patients with acute ischemic stroke. We aimed to determine whether procedural volumes at an academic health sciences centre in northeastern Ontario exceeded the minimum of 20 procedures annually to support establishment of an endovascular therapy centre and thus improve regional access to this type of care. METHODS We conducted a retrospective chart review at Health Sciences North, a regional stroke centre for northeastern Ontario that currently does not offer endovascular therapy for patients with acute ischemic stroke. Medical records and neurovascular imaging results for patients with a discharge diagnosis of cerebral infarction who were seen by the stroke on-call team at Health Sciences North between May 1, 2016, and Apr. 30, 2017, were retrospectively examined in accordance with criteria of the ESCAPE trial to identify potential candidates for endovascular therapy. The number of candidates was extrapolated to include patients discharged with cerebral infarction from referral centres within a 2-hour transport radius from the study institution. RESULTS Of 71 patients who met the inclusion criteria, 9 were identified as candidates. Of the 71 cases reviewed, 62 (87%) presented within the window for administration of recombinant tissue plasminogen activator of 4.5 hours from symptom onset, 66 (93%) within the endovascular therapy window of 6 hours and 69 (97%) within the extended endovascular therapy window of 12 hours. Expanding these estimates to include regional referral centres, we conservatively estimated that Health Sciences North has the potential to perform 22 or 23 procedures annually. INTERPRETATION The projected annual number of procedures met the minimum requirement to maintain competency. Establishing Health Sciences North as a centre for endovascular therapy could be an important step in improving equity in stroke outcomes across northeastern Ontario.
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Affiliation(s)
- Brian Lauzon
- Northeastern Ontario Stroke Network (Lauzon, Corrigan-Lauzon, Bursey, Puranam), and Department of Diagnostic Imaging (Grynspan), Health Sciences North, Sudbury, Ont.; Joint Department of Medical Imaging (Krings), Toronto Western Hospital and University Health Network, University of Toronto, Toronto, Ont
| | - Catherine Corrigan-Lauzon
- Northeastern Ontario Stroke Network (Lauzon, Corrigan-Lauzon, Bursey, Puranam), and Department of Diagnostic Imaging (Grynspan), Health Sciences North, Sudbury, Ont.; Joint Department of Medical Imaging (Krings), Toronto Western Hospital and University Health Network, University of Toronto, Toronto, Ont
| | - Jonathan Grynspan
- Northeastern Ontario Stroke Network (Lauzon, Corrigan-Lauzon, Bursey, Puranam), and Department of Diagnostic Imaging (Grynspan), Health Sciences North, Sudbury, Ont.; Joint Department of Medical Imaging (Krings), Toronto Western Hospital and University Health Network, University of Toronto, Toronto, Ont
| | - Susan Bursey
- Northeastern Ontario Stroke Network (Lauzon, Corrigan-Lauzon, Bursey, Puranam), and Department of Diagnostic Imaging (Grynspan), Health Sciences North, Sudbury, Ont.; Joint Department of Medical Imaging (Krings), Toronto Western Hospital and University Health Network, University of Toronto, Toronto, Ont
| | - Timo Krings
- Northeastern Ontario Stroke Network (Lauzon, Corrigan-Lauzon, Bursey, Puranam), and Department of Diagnostic Imaging (Grynspan), Health Sciences North, Sudbury, Ont.; Joint Department of Medical Imaging (Krings), Toronto Western Hospital and University Health Network, University of Toronto, Toronto, Ont
| | - Padma Puranam
- Northeastern Ontario Stroke Network (Lauzon, Corrigan-Lauzon, Bursey, Puranam), and Department of Diagnostic Imaging (Grynspan), Health Sciences North, Sudbury, Ont.; Joint Department of Medical Imaging (Krings), Toronto Western Hospital and University Health Network, University of Toronto, Toronto, Ont.
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22
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Sacks D, Baxter B, Campbell BCV, Carpenter JS, Cognard C, Dippel D, Eesa M, Fischer U, Hausegger K, Hirsch JA, Hussain MS, Jansen O, Jayaraman MV, Khalessi AA, Kluck BW, Lavine S, Meyers PM, Ramee S, Rüfenacht DA, Schirmer CM, Vorwerk D. Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke. AJNR Am J Neuroradiol 2018; 39:E61-E76. [PMID: 29773566 PMCID: PMC7410632 DOI: 10.3174/ajnr.a5638] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- D Sacks
- From the Department of Interventional Radiology (D.S.), The Reading Hospital and Medical Center, West Reading, Pennsylvania
| | - B Baxter
- Department of Radiology (B.B.), Erlanger Medical Center, Chattanooga, Tennessee
| | - B C V Campbell
- Departments of Medicine and Neurology (B.C.V.C.), Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - J S Carpenter
- Department of Radiology (J.S.C.), West Virginia University, Morgantown, West Virginia
| | - C Cognard
- Department of Diagnostic and Therapeutic Neuroradiology (C.C.), Centre Hospitalier Universitaire de Toulouse, Hôpital Purpan, Toulouse, France
| | - D Dippel
- Department of Neurology (D.D.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Eesa
- Department of Radiology (M.E.), University of Calgary, Calgary, Alberta, Canada
| | - U Fischer
- Department of Neurology (U.F.), Inselspital-Universitätsspital Bern, Bern, Switzerland
| | - K Hausegger
- Department of Radiology (K.H.), Klagenfurt State Hospital, Klagenfurt am Wörthersee, Austria
| | - J A Hirsch
- Neuroendovascular Program, Department of Radiology (J.A.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - M S Hussain
- Cerebrovascular Center, Neurological Institute (M.S.H.), Cleveland Clinic, Cleveland, Ohio
| | - O Jansen
- Department of Radiology and Neuroradiology (O.J.), Klinik für Radiologie und Neuroradiologie, Kiel, Germany
| | - M V Jayaraman
- Departments of Diagnostic Imaging, Neurology, and Neurosurgery (M.V.J.), Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, Rhode Island
| | - A A Khalessi
- Department of Surgery (A.A.K.), University of California San Diego Health, San Diego, California
| | - B W Kluck
- Interventional Cardiology (B.W.K.), Heart Care Group, Allentown, Pennsylvania
| | - S Lavine
- Departments of Neurological Surgery and Radiology (S.L.), Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - P M Meyers
- Departments of Radiology and Neurological Surgery (P.M.M.), Columbia University College of Physicians and Surgeons, New York, New York
| | - S Ramee
- Interventional Cardiology, Heart and Vascular Institute (S.R.), Ochsner Medical Center, New Orleans, Louisiana
| | - D A Rüfenacht
- Neuroradiology Division (D.A.R.), Swiss Neuro Institute-Clinic Hirslanden, Zürich, Switzerland
| | - C M Schirmer
- Department of Neurosurgery and Neuroscience Center (C.M.S.), Geisinger Health System, Wilkes-Barre, Pennsylvania
| | - D Vorwerk
- Diagnostic and Interventional Radiology Institutes (D.V.), Klinikum Ingolstadt, Ingolstadt, Germany
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23
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Leslie-Mazwi T, Chandra RV, Fraser JF, Hoh B, Baxter BW, Albuquerque FC, Hirsch JA. AHA/ASA 2018 AIS guidelines: impact and opportunity for endovascular stroke care. J Neurointerv Surg 2018; 10:813-817. [PMID: 29807886 DOI: 10.1136/neurintsurg-2018-013911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Thabele Leslie-Mazwi
- Departments of Neurosurgery and Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronil V Chandra
- Department of Radiology, Monash University, Melbourne, Victoria, Australia
| | - Justin F Fraser
- Departments of Neurological Surgery, Neurology, Radiology, and Neuroscience, University of Kentucky, Lexington, Kentucky, USA
| | - Brian Hoh
- Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Blaise W Baxter
- Tennessee Interventional & Imaging Associates/Erlanger, Chattanooga, Tennessee, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Joshua A Hirsch
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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24
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Kaschner MG, Caspers J, Rubbert C, Lande R, Kraus B, Lee JI, Gliem M, Jander S, Turowski B. Mechanical thrombectomy in MCA-mainstem occlusion in patients with low NIHSS scores. Interv Neuroradiol 2018. [PMID: 29540086 DOI: 10.1177/1591019918760747] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Introduction While effectiveness of mechanical thrombectomy (MTE) in M1 segment occlusion is approved for patients with severe impairment, there is a lack of evidence for a potential benefit of MTE in patients with minor to moderate symptoms. The purpose of this study was to evaluate neurological outcome and occurrence of periprocedural complications after MTE in patients with low National Institutes of Health Stroke Scale (NIHSS) scores. Materials and methods A retrospective analysis of 1081 consecutive patients with anterior circulation ischemic stroke due to M1 occlusion detected by computed tomography angiography and treated with MTE at our hospital between February 2012 and November 2017 was performed. NIHSS, Barthel Index (BI) and modified Rankin Scale (mRS) scores between admission and discharge were compared with paired Mann-Whitney test, and recanalization rate and complications were assessed in patients with NIHSS ≤ 5 at admission. Results Thirty patients were included with a median NIHSS score of 4. NIHSS score (median: 4 vs. 1; p < 0.001), BI (median: 43 vs. 80; p < 0.001) and mRS (2 vs. 1; p < 0.001) showed significant improvement from admission to discharge after MTE. Recanalization rate was Thrombolysis in Cerebral Infarction (TICI) 2b to 3 in 29 of 30 patients (96.7%). One case of an intracerebral reperfusion hematoma (ECASS: PH2) required surgical treatment. Conclusion MTE might lead to a significantly improved clinical outcome also for patients with low NIHSS score due to M1 segment occlusion. Periprocedural complications appeared infrequently. These results encourage further evaluation of the benefit-risk profile of MTE compared to standard treatment in patients with low NIHSS scores in future randomized trials.
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Affiliation(s)
| | - Julian Caspers
- Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | | | - Raul Lande
- Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Bastian Kraus
- Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - John-Ih Lee
- Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Michael Gliem
- Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | | | - Bernd Turowski
- Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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Multisociety Consensus Quality Improvement Revised Consensus Statement for Endovascular Therapy of Acute Ischemic Stroke: From the American Association of Neurological Surgeons (AANS), American Society of Neuroradiology (ASNR), Cardiovascular and Interventional Radiology Society of Europe (CIRSE), Canadian Interventional Radiology Association (CIRA), Congress of Neurological Surgeons (CNS), European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), European Stroke Organization (ESO), Society for Cardiovascular Angiography and Interventions (SCAI), Society of Interventional Radiology (SIR), Society of NeuroInterventional Surgery (SNIS), and World Stroke Organization (WSO). J Vasc Interv Radiol 2018; 29:441-453. [PMID: 29478797 DOI: 10.1016/j.jvir.2017.11.026] [Citation(s) in RCA: 156] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 01/19/2023] Open
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Haldis T, Manchak M, Kouznetsov E, Remund T, Drofa A. Our experience training a neurocardiologist: a case for an emerging specialty. EUROINTERVENTION 2018; 13:1975-1976. [DOI: 10.4244/eij-d-17-00684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Halvorsrud K, Flynn D, Ford GA, McMeekin P, Bhalla A, Balami J, Craig D, White P. A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England. BMC Health Serv Res 2018; 18:135. [PMID: 29471828 PMCID: PMC5824465 DOI: 10.1186/s12913-018-2922-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/06/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Intra-arterial thrombectomy is the gold standard treatment for large artery occlusive stroke. However, the evidence of its benefits is almost entirely based on trials delivered by experienced neurointerventionists working in established teams in neuroscience centres. Those responsible for the design and prospective reconfiguration of services need access to a comprehensive and complementary array of information on which to base their decisions. This will help to ensure the demonstrated effects from trials may be realised in practice and account for regional/local variations in resources and skill-sets. One approach to elucidate the implementation preferences and considerations of key experts is a Delphi survey. In order to support commissioning decisions, we aimed using an electronic Delphi survey to establish consensus on the options for future organisation of thrombectomy services among physicians with clinical experience in managing large artery occlusive stroke. METHODS A Delphi survey was developed with 12 options for future organisation of thrombectomy services in England. A purposive sampling strategy established an expert panel of stroke physicians from the British Association of Stroke Physicians (BASP) Clinical Standards and/or Executive Membership that deliver 24/7 intravenous thrombolysis. Options with aggregate scores falling within the lowest quartile were removed from the subsequent Delphi round. Options reaching consensus following the two Delphi rounds were then ranked in a final exercise by both the wider BASP membership and the British Society of Neuroradiologists (BSNR). RESULTS Eleven stroke physicians from BASP completed the initial two Delphi rounds. Three options achieved consensus, with subsequently wider BASP (97%, n = 43) and BSNR members (86%, n = 21) assigning the highest approval rankings in the final exercise for transferring large artery occlusive stroke patients to nearest neuroscience centre for thrombectomy based on local CT/CT Angiography. CONCLUSIONS The initial Delphi rounds ensured optimal reduction of options by an expert panel of stroke physicians, while subsequent ranking exercises allowed remaining options to be ranked by a wider group of experts within stroke to reach consensus. The preferred implementation option for thrombectomy is investigating suspected acute stroke patients by CT/CT Angiography and secondary transfer of large artery occlusive stroke patients to the nearest neuroscience (thrombectomy) centre.
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Affiliation(s)
- Kristoffer Halvorsrud
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Darren Flynn
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
| | - Gary A. Ford
- Institute of Neuroscience, Newcastle University, 3-4, Claremont Terrace, Newcastle upon Tyne, NE2 4AX UK
- Oxford University Hospitals NHS Trust and Oxford University, Oxford, UK
| | - Peter McMeekin
- School of Health, Community and Education Studies, Northumbria University, Newcastle Upon Tyne, UK
| | - Ajay Bhalla
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Joyce Balami
- Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
| | - Dawn Craig
- Institute of Health and Society Newcastle University, Newcastle Upon Tyne, UK
| | - Phil White
- Institute of Neuroscience, Newcastle University, 3-4, Claremont Terrace, Newcastle upon Tyne, NE2 4AX UK
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Leslie-Mazwi T, Chandra RV, Baxter BW, Arthur AS, Hussain MS, Singh IP, Frei DF, Klucznik RP, Albuquerque FC, Hirsch JA. ELVO: an operational definition. J Neurointerv Surg 2018; 10:507-509. [DOI: 10.1136/neurintsurg-2018-013792] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2018] [Indexed: 11/04/2022]
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Widimsky P. When will acute stroke interventions be as widely available as primary PCI? EUROINTERVENTION 2017; 13:1269-1272. [PMID: 29260719 DOI: 10.4244/eijv13i11a200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Petr Widimsky
- Cardiocenter, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University, Prague, Czech Republic
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The organisation of the acute ischemic stroke management: key notes of the Italian Neurological Society and of the Italian Stroke Organization. Neurol Sci 2017; 39:415-422. [DOI: 10.1007/s10072-017-3200-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 11/17/2017] [Indexed: 01/19/2023]
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Peter R, Emmer BJ, van Es AC, van Walsum T. Quantitative Analysis of Geometry and Lateral Symmetry of Proximal Middle Cerebral Artery. J Stroke Cerebrovasc Dis 2017; 26:2427-2434. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/24/2017] [Accepted: 05/30/2017] [Indexed: 12/25/2022] Open
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Widimsky P, Doehner W, Diener HC, Van Gelder IC, Halliday A, Mazighi M. The role of cardiologists in stroke prevention and treatment: position paper of the European Society of Cardiology Council on Stroke. Eur Heart J 2017; 39:1567-1573. [DOI: 10.1093/eurheartj/ehx478] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 08/01/2017] [Indexed: 02/03/2023] Open
Affiliation(s)
- Petr Widimsky
- Third Faculty of Medicine, Cardiocenter, Charles University, University Hospital Kralovske Vinohrady, Srobárova 50, 100 00 Prague, Czech Republic
| | - Wolfram Doehner
- Center for Stroke Research Berlin and Department of Cardiology, Campus Virchow, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charite Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hans Christoph Diener
- Department of Neurology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Isabelle C Van Gelder
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Alison Halliday
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Mikael Mazighi
- Stroke Unit Lariboisière Hospital, Interventional Neuroradiology Fondation Rothschild, Denis Diderot University, 2 rue Ambroise Paré, Paris 75010, France
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Day AL, Siddiqui AH, Meyers PM, Jovin TG, Derdeyn CP, Hoh BL, Riina H, Linfante I, Zaidat O, Turk A, Howington JU, Mocco J, Ringer AJ, Veznedaroglu E, Khalessi AA, Levy EI, Woo H, Harbaugh R, Giannotta S. Training Standards in Neuroendovascular Surgery: Program Accreditation and Practitioner Certification. Stroke 2017; 48:2318-2325. [PMID: 28706116 DOI: 10.1161/strokeaha.117.016560] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/09/2017] [Accepted: 03/15/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Neuroendovascular surgery is a medical subspecialty that uses minimally invasive catheter-based technology and radiological imaging to diagnose and treat diseases of the central nervous system, head, neck, spine, and their vasculature. To perform these procedures, the practitioner needs an extensive knowledge of the anatomy of the nervous system, vasculature, and pathological conditions that affect their physiology. A working knowledge of radiation biology and safety is essential. Similarly, a sufficient volume of clinical and interventional experience, first as a trainee and then as a practitioner, is required so that these treatments can be delivered safely and effectively. METHODS This document has been prepared under the aegis of the Society of Neurological Surgeons and its Committee for Advanced Subspecialty Training in conjunction with the Joint Section of Cerebrovascular Surgery for the American Association of Neurological Surgeons and Congress of Neurological Surgeons, the Society of NeuroInterventional Surgery, and the Society of Vascular and Interventional Neurology. RESULTS The material herein outlines the requirements for institutional accreditation of training programs in neuroendovascular surgery, as well as those needed to obtain individual subspecialty certification, as agreed on by Committee for Advanced Subspecialty Training, the Society of Neurological Surgeons, and the aforementioned Societies. This document also clarifies the pathway to certification through an advanced practice track mechanism for those current practitioners of this subspecialty who trained before Committee for Advanced Subspecialty Training standards were formulated. CONCLUSIONS Representing neuroendovascular surgery physicians from neurosurgery, neuroradiology, and neurology, the above mentioned societies seek to standardize neuroendovascular surgery training to ensure the highest quality delivery of this subspecialty within the United States.
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Affiliation(s)
- Arthur L Day
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Adnan H Siddiqui
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Philip M Meyers
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Tudor G Jovin
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Colin P Derdeyn
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Brian L Hoh
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Howard Riina
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Italo Linfante
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Osama Zaidat
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Aquilla Turk
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Jay U Howington
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - J Mocco
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Andrew J Ringer
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Erol Veznedaroglu
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Alexander A Khalessi
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Elad I Levy
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Henry Woo
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Robert Harbaugh
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.)
| | - Steven Giannotta
- From the Department of Neurosurgery, Mischer Neuroscience Institute, University of Texas Health Science Center, Houston (A.L.D.); Departments of Neurosurgery and Radiology, School of Medicine and Biomedical Sciences and Toshiba Stroke and Vascular Institute, University at Buffalo, State University of New York (A.H.S., E.I.L.); Jacobs Institute, Buffalo, NY (A.H.S., E.I.L.); Departments of Radiology and Neurological Surgery, College of Physicians and Surgeons, Columbia University, New York, NY (P.M.M.); Departments of Neurology and Neurosurgery, University of Pittsburgh Medical Center, PA (T.G.J.); Departments of Radiology, Neurology, and Neurosurgery, University of Iowa Hospitals and Clinics (C.P.D.); Department of Neurosurgery, University of Florida, Gainesville (B.L.H.); Department of Neurosurgery, NYU Langone Medical Center (H.R.); Departments of Radiology and Neuroscience, Miami Cardiac and Vascular Institute and Baptist Neuroscience Institute, FL (I.L.); Mercy Endovascular-Neuroscience, Toledo, OH (O.Z.); Department of Neurosurgery, Medical University of South Carolina, Charleston (A.T.); Department of Neurosurgery, Neurological Institute of Savannah, GA (J.U.H.); Department of Neurosurgery, Mount Sinai Health System, New York, NY (J.M.); Department of Neurosurgery, Mayfield Clinic and University of Cincinnati College of Medicine, OH (A.J.R.); Department of Neurosurgery, Capital Health System, Trenton, NJ (E.V.); Department of Neurosurgery, University of California, San Diego (A.A.K.); Departments of Neurosurgery and Radiology, Stony Brook School of Medicine, East Setauket, NY (H.W.); Department of Neurosurgery, Penn State University-Milton S. Hershey Medical Center, Hershey, PA (R.H.); and Department of Neurosurgery, Keck School of Medicine of the University of Southern California, Los Angeles (S.G.).
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Sacks D. Interventional Radiologists and Endovascular Therapy for Acute Ischemic Strokes. J Vasc Interv Radiol 2017; 28:1137-1140. [PMID: 28735933 DOI: 10.1016/j.jvir.2017.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/05/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- David Sacks
- Department of Interventional Radiology, Reading Health System, 6th and Spruce Sts., West Reading, PA 19612.
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Sultan-Qurraie A, Rozansky G, Cox JA, Lazzaro M. Cross-circulation thrombectomy with use of a stent retriever: A case report. Interv Neuroradiol 2017; 23:422-426. [PMID: 28480772 DOI: 10.1177/1591019917706191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction The efficacy of the endovascular treatment of acute ischemic stroke has been substantiated by several recent randomized clinical trials. While intra-arterial therapy has significantly evolved in recent years, anatomic cerebrovascular variants and disease burden can present challenges to timely recanalization. We present the first reported case of anterior-to-posterior mechanical clot retrieval with use of a stent retriever. Case description A 53-year-old man presented with basilar artery thrombosis. Endovascular mechanical clot retrieval was performed. The typical, antegrade, access to the basilar artery thrombus was precluded by the findings of a hypoplastic left vertebral artery and an occluded proximal right vertebral artery. Given a number of factors including the patient's worsening symptoms and the high morbidity and mortality associated with basilar stroke, cross-circulation-anterior-to-posterior-intra-arterial therapy was performed. Thrombectomy of the basilar thrombus was achieved via the right internal carotid artery and right posterior communicating artery. Conclusion To our knowledge, we report the first case of cross-circulation, anterior-to-posterior thrombectomy, with the use of a stent-retriever device. Cross-circulation stroke treatment may be beneficial in cases of proximal vessel occlusion or anatomical constraints. Larger studies will need to evaluate the safety and efficacy of these approaches.
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Affiliation(s)
| | | | | | - Marc Lazzaro
- Medical College of Wisconsin, Milwaukee, WI, USA
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Kiernan MC. Transforming the management of stroke. Med J Aust 2017; 206:342-343. [PMID: 28446114 DOI: 10.5694/mja17.00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/30/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew C Kiernan
- Bushell Chair of Neurology, Royal Prince Alfred Hospital, Sydney, NSW
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Papassin J, Favre-Wiki IM, Atroun T, Tahon F, Boubagra K, Rodier G, Bing F, Marcel S, Vallot C, Belle L, Hommel M, Detante O. Patient eligibility for thrombectomy after acute stroke: Northern French Alps database analysis. Rev Neurol (Paris) 2017; 173:216-221. [PMID: 28377089 DOI: 10.1016/j.neurol.2017.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/09/2016] [Accepted: 03/09/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since 2015, the emergence of mechanical thrombectomy as standard care in acute stroke has involved organizational changes not only for stroke centers, but also for entire emergency regional networks. The aim of our study was to assess the proportion of ischemic stroke patients, admitted to stroke units in the Northern French Alps within the first 6h of onset, eligible for thrombectomy. METHODS This study retrospectively analyzed the clinical and radiological data of all acute stroke patients hospitalized at three stroke units of the Northern French Alps Emergency Network (RENAU) in 2014. Eligible patients had proximal arterial occlusions of the anterior and posterior cerebral circulation, as confirmed by brain imaging, which could be treated by thrombectomy within 6h of symptom onset. RESULTS Of the 435 cases of acute ischemic stroke, 152 patients were treated by intravenous thrombolysis (IV rtPA). Of these patients, 83 (55%) had intracranial occlusions and were eligible for combined thrombectomy. Of the 283 patients not treatable by IV rtPA, 32 patients (11%) were eligible for primary thrombectomy. CONCLUSION Thrombectomy could be performed in 26% of our acute ischemic stroke patients (n=115/435), and a large increase in endovascular procedures is expected over the next few years that will require close collaboration among all partners in the emergency networks. Using our RENAU stroke database, it will be possible to compare various factors contributing to effective activity.
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Affiliation(s)
- J Papassin
- Department of neurology, stroke unit, CHU Grenoble-Alpes, 38043 Grenoble, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France.
| | - I M Favre-Wiki
- Department of neurology, stroke unit, CHU Grenoble-Alpes, 38043 Grenoble, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - T Atroun
- Department of neurology, stroke unit, CHU Grenoble-Alpes, 38043 Grenoble, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - F Tahon
- Department of radiology, CHU Grenoble-Alpes, 38043 Grenoble, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - K Boubagra
- Department of radiology, CHU Grenoble-Alpes, 38043 Grenoble, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - G Rodier
- Department of neurology, Stroke Unit, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - F Bing
- Department of radiology, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - S Marcel
- Department of neurology, stroke unit, centre hospitalier Métropole Savoie, 73000 Chambéry, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - C Vallot
- RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - L Belle
- RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France
| | - M Hommel
- Department of neurology, stroke unit, CHU Grenoble-Alpes, 38043 Grenoble, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France; Université Grenoble-Alpes, 38400 Saint-Martin-d'Hères, France
| | - O Detante
- Department of neurology, stroke unit, CHU Grenoble-Alpes, 38043 Grenoble, France; RENAU network, centre hospitalier d'Annecy-Genevois, 74370 Epagny Metz-Tessy, France; Université Grenoble-Alpes, 38400 Saint-Martin-d'Hères, France
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Barlinn J, Gerber J, Barlinn K, Pallesen LP, Siepmann T, Zerna C, Wojciechowski C, Puetz V, von Kummer R, Reichmann H, Linn J, Bodechtel U. Acute endovascular treatment delivery to ischemic stroke patients transferred within a telestroke network: a retrospective observational study. Int J Stroke 2016; 12:502-509. [PMID: 27899742 DOI: 10.1177/1747493016681018] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Five randomized controlled trials recently demonstrated efficacy of endovascular treatment in acute ischemic stroke. Telestroke networks can improve stroke care in rural areas but their role in patients undergoing endovascular treatment is unknown. Aim We compared clinical outcomes of endovascular treatment between anterior circulation stroke patients transferred after teleconsultation and those directly admitted to a tertiary stroke center. Methods Data derived from consecutive patients with intracranial large vessel occlusion who underwent endovascular treatment from January 2010 to December 2014 at our tertiary stroke center. We compared baseline characteristics, onset-to-treatment times, symptomatic intracranial hemorrhage, in-hospital mortality, reperfusion (modified Treatment in Cerebral Infarction 2b/3), and favorable functional outcome (modified Rankin scale ≤ 2) at discharge between patients transferred from spoke hospitals and those directly admitted. Results We studied 151 patients who underwent emergent endovascular treatment for anterior circulation stroke: median age 70 years (interquartile range, 62-75); 55% men; median National Institutes of Health Stroke Scale score 15 (12-20). Of these, 48 (31.8%) patients were transferred after teleconsultation and 103 (68.2%) were primarily admitted to our emergency department. Transferred patients were younger (p = 0.020), received more frequently intravenous tissue plasminogen activator (p = 0.008), had prolonged time from stroke onset to endovascular treatment initiation (p < 0.0001) and tended to have lower rates of symptomatic intracranial hemorrhage (4.2% vs. 11.7%; p = 0.227) and mortality (8.3% vs. 22.6%; p = 0.041) than directly admitted patients. Similar rates of reperfusion (56.2% vs. 61.2%; p = 0.567) and favorable functional outcome (18.8% vs. 13.7%; p = 0.470) were observed in telestroke patients and those who were directly admitted. Conclusions Telestroke networks may enable delivery of endovascular treatment to selected ischemic stroke patients transferred from remote hospitals that is equitable to patients admitted directly to tertiary hospitals.
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Affiliation(s)
- Jessica Barlinn
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Johannes Gerber
- 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Kristian Barlinn
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Lars-Peder Pallesen
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Timo Siepmann
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Charlotte Zerna
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | | | - Volker Puetz
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Rüdiger von Kummer
- 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Heinz Reichmann
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Jennifer Linn
- 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany
| | - Ulf Bodechtel
- 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany
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Fiehler J, Cognard C, Gallitelli M, Jansen O, Kobayashi A, Mattle HP, Muir KW, Mazighi M, Schaller K, Schellinger PD. European recommendations on organisation of interventional care in acute stroke (EROICAS). Eur Stroke J 2016; 1:155-170. [PMID: 31008277 DOI: 10.1177/2396987316659033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Jens Fiehler
- Department of Neuroradiology, University Medical Center, Hamburg, Germany
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Mauro Gallitelli
- Emergency Department, Ospedale "Santi Giovanni e Paolo", Venice, Italy
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - Adam Kobayashi
- 2nd Department of Neurology and Interventional Stroke and Cerebrovascular Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Mikael Mazighi
- Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, Paris, France
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva, Medical Center, Geneva, Switzerland
| | - Peter D Schellinger
- Departments of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Minden, Germany
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Fiehler J, Cognard C, Gallitelli M, Jansen O, Kobayashi A, Mattle HP, Muir KW, Mazighi M, Schaller K, Schellinger PD. European Recommendations on Organisation of Interventional Care in Acute Stroke (EROICAS). Int J Stroke 2016; 11:701-16. [DOI: 10.1177/1747493016647735] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Jens Fiehler
- Department of Neuroradiology, University Medical Center, Hamburg, Germany
| | - Christophe Cognard
- Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Mauro Gallitelli
- Emergency Department, Ospedale “Santi Giovanni e Paolo”, Venice, Italy
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Medical Center of Schleswig-Holstein, Campus Kiel, Germany
| | - Adam Kobayashi
- 2nd Department of Neurology and Interventional Stroke and Cerebrovascular Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Heinrich P Mattle
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland, United Kingdom
| | - Mikael Mazighi
- Department of Neurology and Stroke Center, AP-HP, Lariboisière Hospital, Paris, France
| | - Karl Schaller
- Department of Neurosurgery, University of Geneva, Medical Center, Geneva, Switzerland
| | - Peter D Schellinger
- Departments of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Minden, Germany
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Cabral NL, Conforto A, Magalhaes PSC, Longo AL, Moro CHC, Appel H, Wille P, Nagel V, Venancio V, Garcia AC, Mazin SC, Goncalves ARR. Intravenous rtPA versus mechanical thrombectomy in acute ischemic stroke: A historical cohort in Joinville, Brazil. eNeurologicalSci 2016; 5:1-6. [PMID: 29430550 PMCID: PMC5803111 DOI: 10.1016/j.ensci.2016.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 04/08/2016] [Accepted: 04/11/2016] [Indexed: 11/16/2022] Open
Abstract
Groundbreaking results concerning ischemic stroke (IS) hyperacute treatment worldwide were published in 2014 and 2015. We aimed to compare functional status after 3 months in patients treated with intra-arterial thrombectomy (IAT) and those treated with intravenous thrombolysis (IVT) alone in Joinville, Brazil. From the Joinville Stroke Registry, we extracted and compared all consecutive IVT patients treated with r-tPA within 4.5 h in the period 2009–2011 versus all consecutive IAT treated within 6 h with the Solitaire FR device plus IVT in the period 2012–2014. We registered 82 patients in the IVT group and 31 patients in the IAT group. At hospital admission, patients in the IAT group were significantly younger (p < 0.001), had a higher educational level (p = 0.001), had a slightly higher prevalence of atrial fibrillation (p = 0.057) and had more severe strokes measured by the NIH stroke scale (p = 0.011). After 90 days, 45% of patients in the IAT group and 27% in the IVT group were independent (0–1 points) according to the modified Rankin scale (adjusted odds ratio: 4.53; 95% CI: 1.22 to 16.75). Symptomatic hemorrhage was diagnosed in 10% of patients in both groups (p = 1.0). The 90-day case-fatality was 39% (32/82) in the IVT group and 26% (8/31) in the IAT group (p = 0.27). In this small cohort, a greater rate of functional independence was achieved in patients treated with IAT plus IVT, compared with patients treated with IVT lysis alone. Our “real-world” findings are consistent with results of controlled, randomized clinical trials. Incidence of ischemic stroke have been increasing in low and middle income countries ( LMIC) over last 3 decades. Combined intravenous – endovascular approach opened a new era in treatment of ischemic stroke with absolute risk reduction of functional dependency. How far these data might be translated to LMIC settings?
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Affiliation(s)
- Norberto L Cabral
- Joinville Stroke Register, University of Joinville Region, 89219-710 Joinville, Brazil.,Neurology Clinical Division, Hospital Municipal Sao Jose, Joinville, Brazil
| | - Adriana Conforto
- Neurology Clinical Division, Hospital das Clínicas/Sao Paulo University, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Alexandre L Longo
- Joinville Stroke Register, University of Joinville Region, 89219-710 Joinville, Brazil.,Neurology Clinical Division, Hospital Municipal Sao Jose, Joinville, Brazil
| | - Carla H C Moro
- Joinville Stroke Register, University of Joinville Region, 89219-710 Joinville, Brazil.,Neurology Clinical Division, Hospital Municipal Sao Jose, Joinville, Brazil
| | - Hamilton Appel
- Neurology Clinical Division, Hospital Municipal Sao Jose, Joinville, Brazil
| | - Paulo Wille
- Neurology Clinical Division, Hospital Municipal Sao Jose, Joinville, Brazil
| | - Vivian Nagel
- Joinville Stroke Register, University of Joinville Region, 89219-710 Joinville, Brazil
| | - Vanessa Venancio
- Joinville Stroke Register, University of Joinville Region, 89219-710 Joinville, Brazil
| | - Adriana C Garcia
- Joinville Stroke Register, University of Joinville Region, 89219-710 Joinville, Brazil
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