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Grunwald IQ, Musialek P, Podlasek A, Sievert H, Mathias K, Guyler P, Hopkins LN. World Federation for Interventional Stroke Treatment (WIST) multispecialty training guidelines for endovascular stroke intervention: Time is brain! - Response to commentary by UKNG. Clin Radiol 2024; 79:e637-e639. [PMID: 38311524 DOI: 10.1016/j.crad.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/06/2024]
Affiliation(s)
- I Q Grunwald
- NHS Tayside, Dundee, UK; Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.
| | - P Musialek
- Jagiellonian University, Krakow, Poland; Stroke Thrombectomy-Capable Center, John Paul II Hospital, Krakow, Poland
| | - A Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - H Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; Goethe University Frankfurt, Frankfurt, Germany
| | - K Mathias
- Asklepios Clinik St Georg - Klinische und Interventionelle Angiologie, Hamburg, Germany
| | - P Guyler
- East of England Regional Stroke Network, UK; Mid and South Essex University Hospitals Group, Southend University Hospital, Westcliff-on-Sea, UK
| | - L N Hopkins
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY, USA
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Grunwald IQ, Mathias K, Bertog S, Snyder KV, Sievert H, Siddiqui A, Musialek P, Hornung M, Papanagiotou P, Comelli S, Pillai S, Routledge H, Nizankowski RT, Ewart I, Fassbender K, Kühn AL, Alvarez CA, Alekyan B, Skrypnik D, Politi M, Tekieli L, Haldis T, Gaikwad S, Houston JG, Donald-Simpson H, Guyler P, Petrov I, Roffe C, Abelson M, Hargroves D, Mani S, Podlasek A, Witkowski A, Sievert K, Pawlowski K, Dziadkiewicz A, Hopkins NL. World Federation for Interventional Stroke Treatment (WIST) Multispecialty Training Guidelines for Endovascular Stroke Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53:67-72. [PMID: 37012107 DOI: 10.1016/j.carrev.2023.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/09/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Today, endovascular treatment (EVT) is the therapy of choice for strokes due to acute large vessel occlusion, irrespective of prior thrombolysis. This necessitates fast, coordinated multi-specialty collaboration. Currently, in most countries, the number of physicians and centres with expertise in EVT is limited. Thus, only a small proportion of eligible patients receive this potentially life-saving therapy, often after significant delays. Hence, there is an unmet need to train a sufficient number of physicians and centres in acute stroke intervention in order to allow widespread and timely access to EVT. AIM To provide multi-specialty training guidelines for competency, accreditation and certification of centres and physicians in EVT for acute large vessel occlusion strokes. MATERIAL AND METHODS The World Federation for Interventional Stroke Treatment (WIST) consists of experts in the field of endovascular stroke treatment. This interdisciplinary working group developed competency - rather than time-based - guidelines for operator training, taking into consideration trainees' previous skillsets and experience. Existing training concepts from mostly single specialty organizations were analysed and incorporated. RESULTS The WIST establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in EVT. WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. CONCLUSIONS WIST multispecialty guidelines outline competency and quality standards for physicians and centres to perform safe and effective EVT. The role of quality control and quality assurance is highlighted. SUMMARY The World Federation for Interventional Stroke Treatment (WIST) establishes an individualized approach to acquiring clinical knowledge and procedural skills to meet the competency requirements for certification of interventionalists of various disciplines and stroke centres in endovascular treatment (EVT). WIST guidelines encourage acquisition of skills using innovative training methods such as structured supervised high-fidelity simulation and procedural performance on human perfused cadaveric models. WIST multispecialty guidelines outline competency and quality standards for physicians and centers to perform safe and effective EVT. The role of quality control and quality assurance is highlighted. SIMULTANEOUS PUBLICATION The WIST 2023 Guidelines are published simultaneously in Europe (Adv Interv Cardiol 2023).
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Affiliation(s)
- Iris Q Grunwald
- Department of Radiology, NHS Tayside, Dundee, UK; Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany.
| | - Klaus Mathias
- Asklepios Clinik St. Georg-Klinische und Interventionelle Angiologie, Hamburg, Germany
| | - Stefan Bertog
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; Minneapolis Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
| | - Horst Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
| | - Adnan Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
| | - Piotr Musialek
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | - Marius Hornung
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany; SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | - Panagiotes Papanagiotou
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany; First Department of Radiology, School of Medicine, National & Kapodistrian University of Athens, Areteion Hospital, Athens, Greece
| | - Simone Comelli
- S. C. Neuroradiologia ed Interventistica Vascolare, Ospedale S. Michele, Cagliari, Italy
| | | | - Helen Routledge
- Worcestershire Royal Hospital, Cardiology Department, Worcester, United Kingdom
| | - Rafal T Nizankowski
- Accreditation Council, National Centre for Health Quality Assessment, Krakow, Poland
| | - Ian Ewart
- Mid and South Essex NHS Foundation Trust, United Kingdom
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Anna L Kühn
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, USA
| | - Carlos A Alvarez
- Hospital Italiano Regional Del Sur, Hospital Privado Del Sur and Hospital Regional Español, Bahia Blanca, Argentina
| | | | - Dmitry Skrypnik
- I.V. Davidovsky City Hospital, Moscow State University and Dentistry, Moscow, Russia
| | - Maria Politi
- Department of Diagnostic and Interventional Neuroradiology, Hospital Bremen-Mitte/Bremen-Ost, Bremen, Germany
| | - Lukasz Tekieli
- Department of Cardiac and Vascular Diseases, Jagiellonian University, John Paul II Hospital, Krakow, Poland
| | | | - Shailesh Gaikwad
- Department of Neuroimaging and Interventional Neuroradiology, Neurosciences Center, Ansari Nagar, All India Institute of Medical Sciences (A.I.I.M.S), New Delhi, India
| | - John Graeme Houston
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - Helen Donald-Simpson
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK
| | - Paul Guyler
- Mid and South Essex NHS Foundation Trust, United Kingdom
| | - Ivo Petrov
- Department of Cardiology and Angiology, Acibadem City Clinic-Cardiovascular Center, Sofia, Bulgaria
| | - Christine Roffe
- University Hospital of North Midlands, Keele University, Stoke-on-Trent, UK
| | - Mark Abelson
- Vergelegen MediClinic, Somerset West, University of Cape Town, South Africa
| | - David Hargroves
- East Kent Hospitals University NHS Foundation Trust, Ashford, United Kingdom
| | | | - Anna Podlasek
- Tayside Innovation MedTech Ecosystem (TIME), Division of Imaging Science and Technology, School of Medicine, University of Dundee, UK; Precision Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Adam Witkowski
- Deptartment of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Kolja Sievert
- Cardiovascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
| | - Krzysztof Pawlowski
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, Wejherowo, Poland
| | - Artur Dziadkiewicz
- Department of Neurology and Stroke, Pomeranian Hospitals, Wejherowo, Poland
| | - Nelson L Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY, USA; Jacobs Institute, Buffalo, NY
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Pawłowski K, Dziadkiewicz A, Podlasek A, Klaudel J, Mączkowiak A, Szołkiewicz M. Thrombectomy-Capable Stroke Centre-A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2232. [PMID: 36767599 PMCID: PMC9915992 DOI: 10.3390/ijerph20032232] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/16/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity-thrombectomy-capable stroke centre (TCSC)-was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis-the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes.
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Affiliation(s)
- Krzysztof Pawłowski
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Artur Dziadkiewicz
- Department of Neurology and Stroke, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Anna Podlasek
- Tayside Innovation Medtech Ecosystem (TIME), University of Dundee, Dundee DD1 4HN, UK
- Precision Imaging Beacon, Radiological Sciences, University of Nottingham, Nottingham NG7 2RD, UK
| | - Jacek Klaudel
- Department of Invasive Cardiology, St. Adalbert’s Hospital, Copernicus PL, 80-070 Gdansk, Poland
| | - Alicja Mączkowiak
- Department of Neurology and Stroke, Pomeranian Hospitals, 84-200 Wejherowo, Poland
| | - Marek Szołkiewicz
- Department of Cardiology and Interventional Angiology, Kashubian Center for Heart and Vascular Diseases, Pomeranian Hospitals, 84-200 Wejherowo, Poland
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Carvalho de Campos Martins E, Luiz de Melo Bernardi F. Interventional Cardiologists in the Interdisciplinary Stroke Team: We Are Already Here, Contributing! JACC Cardiovasc Interv 2022; 15:559-561. [PMID: 35151609 DOI: 10.1016/j.jcin.2021.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
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Wita K, Kułach A, Wilkosz K, Wybraniec M, Wojakowski W, Kuczmik W, Lelek M, Tomalski W, Ochała A, Uchwat U, Lasek-Bal A. Mechanical Thrombectomy in Acute Ischemic Stroke-The Role of Interventional Cardiologists: A Prospective Single-Center Study. JACC Cardiovasc Interv 2022; 15:550-558. [PMID: 35151607 DOI: 10.1016/j.jcin.2021.11.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/25/2021] [Accepted: 11/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to assess the safety and outcomes of mechanical thrombectomy (MT) performed at a stroke center by interventional cardiologists (ICs) compared with other interventionists. The primary endpoint was functional independence of stroke survivors (modified Rankin scale score 0-2) at 3 months. The secondary endpoints included recanalization rate, reduction in stroke severity, and 3-month mortality. BACKGROUND MT is a validated treatment for large vessel occlusion acute ischemic stroke. Incorporating ICs with their infrastructure into a comprehensive stroke team may increase the accessibility of this therapy. METHODS In this single-center, prospective study, we included 248 ischemic stroke patients (mean age 68 ± 13 years, 48% women) with confirmed large vessel occlusion. The procedures were performed by ICs (n = 80), vascular surgeons (n = 116), and neuroradiologists (n = 52). RESULTS Functional independence after 3 months was similar between patients operated by cardiologists and other specialists (modified Rankin scale score 0-2 in 44% vs 55%; P = 0.275). Similarly, the mortality rate at 3 months did not differ (28% vs 31%; P = 0.585). Procedures performed by cardiologists took longer than those performed by other specialists (120 minutes vs 105 minutes; P = 0.020). A percentage of procedures with angiographic success (TICI [Thrombolysis In Cerebral Infarction] grade 2b or 3) was lower when performed by cardiologists (55.7% vs 71.7%; P = 0.013), but the change in stroke severity (National Institutes of Health Stroke Scale score after 24 hours) was similar. CONCLUSIONS Endovascular treatment in stroke provided by interventional cardiologists in cooperation with noninvasive stroke specialists is noninferior to procedures performed by the other endovascular specialists. Mortality and functional independence after 3 months are similar regardless of an interventionist performing the procedure.
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Affiliation(s)
- Krystian Wita
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej Kułach
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Katarzyna Wilkosz
- Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maciej Wybraniec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Wojciech Wojakowski
- Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Wacław Kuczmik
- Department of General and Vascular Surgery, Medical University of Silesia, Katowice, Poland
| | - Michał Lelek
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Andrzej Ochała
- Third Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Urszula Uchwat
- Department of Neurology, Upper Silesian Medical Center, Katowice, Poland
| | - Anetta Lasek-Bal
- Department of Neurology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Nardai S, Vorobcsuk A, Nagy F, Vajda Z. Successful endovascular treatment of simultaneous acute ischaemic stroke and hyperacute ST-elevation myocardial infarction: the first case report of a single-operator cardio-cerebral intervention. Eur Heart J Case Rep 2021; 5:ytab419. [PMID: 34746640 PMCID: PMC8567068 DOI: 10.1093/ehjcr/ytab419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/13/2021] [Accepted: 10/11/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Background
The simultaneous management of cardio-cerebral infarctions is an extremely difficult task, as both organs need to receive reperfusion therapy in a limited time to avoid death or permanent disability. The following case is the first published endovascular treatment of synchronous heart and brain infarctions delivered by a single operator with excellent clinical outcome.
Case summary
A 67-year-old female patient was directly transported to the emergency room of a comprehensive stroke centre with acute onset global aphasia and right hemiplegia. The onset to admission time exceeded the 4.5-h time window of systemic thrombolysis. Head computed tomography (CT) excluded extensive early extensive brain damage, CT angiography documented left middle cerebral artery occlusion and mechanical thrombectomy was indicated. Extensive anterior ST elevation was detected on the transport monitor while waiting for in-hospital transfer. The two simultaneously evolving pathologies were handled in a single endovascular procedure that took less than 60 min by a dual-trained interventional cardiologist/neurointerventional surgeon. The patient recovered without any major cardiac or neurologic sequela.
Discussion
Interventional cardiologists, professionally trained through a neurointerventional fellowship programme to perform endovascular stroke interventions according to the latest multi-society position paper, could not only complement stroke teams lacking manpower, but their unique experience could also help the patients suffering from the most devastating forms of cardio-cerebral infarctions.
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Affiliation(s)
- Sándor Nardai
- Semmelweis University, Heart and Vascular Center, Városmajor Street 68, Budapest 1122, Hungary
- Neurointerventional Unit, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
- Corresponding author. Tel: +36 206632722,
| | - András Vorobcsuk
- Department of Cardiology, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
| | - Zsolt Vajda
- Neurointerventional Unit, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street 20-32, Kaposvár 7400, Hungary
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Vavrova J, Koznar B, Peisker T, Vasko P, Rohac F, Sulzenko J, Kroupa J, Stetkarova I, Mengozzi L, Petras M, Widimsky P. Long-term outcomes of thrombectomy for acute ischaemic stroke by occluded artery and stroke aetiology: a PRAGUE-16 substudy. EUROINTERVENTION 2021; 17:e169-e177. [PMID: 32420880 PMCID: PMC9725002 DOI: 10.4244/eij-d-19-00997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thrombectomy is an effective treatment for acute ischaemic stroke (AIS). AIMS The aim of this study was to compare clinical outcomes with intracranial artery occlusion site among AIS patients treated in the setting of a cardiology cath lab. METHODS This was a single-centre, prospective registry of 214 consecutive patients with AIS enrolled between 2012 and 2018. All thrombectomy procedures were performed in a cardiology cath lab with stent retrievers or aspiration systems. The functional outcome was assessed by the modified Rankin Scale (mRS) after three months. RESULTS Ninety-three patients (44%) had middle cerebral artery (MCA) occlusion, 28 patients (13%) had proximal internal carotid artery (ICA) occlusion, 27 patients (13%) had tandem (ICA+MCA) occlusion, 39 patients (18%) had terminal ICA (T-type) occlusion, and 26 patients (12%) had vertebrobasilar (VB) stroke. Favourable clinical outcome (mRS ≤2) was reached in 58% of MCA occlusions and in 56% of isolated ICA occlusions, but in only 31% of T-type occlusions and in 27% of VB stroke. Poor clinical outcome in T-type occlusions and VB strokes was influenced by the lower recanalisation success (mTICI 2b-3 flow) rates: 56% (T-type) and 50% (VB) compared to 82% in MCA occlusions, 89% in isolated ICA occlusions and 96% in tandem occlusions. CONCLUSIONS Catheter-based thrombectomy achieved significantly better clinical results in patients with isolated MCA occlusion, isolated ICA occlusions or tight stenosis and tandem occlusions compared to patients with T-type occlusion and posterior strokes. Visual summary. Endovascular intervention of isolated MCA or ICA occlusions provides greatest clinical benefit, while interventions in posterior circulation have lower chance for clinical success.
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Affiliation(s)
- Jana Vavrova
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Boris Koznar
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Tomas Peisker
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Peter Vasko
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Filip Rohac
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jakub Sulzenko
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Josef Kroupa
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Ivana Stetkarova
- Department of Neurology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Luca Mengozzi
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marek Petras
- Department of Epidemiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimsky
- Cardiocenter, Charles University – Third Faculty of Medicine, and University Hospital Kralovske Vinohrady, Ruska 87, 100 00 Prague 10, Czech Republic
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Nardai S, Lanzer P, Abelson M, Baumbach A, Doehner W, Hopkins LN, Kovac J, Meuwissen M, Roffi M, Sievert H, Skrypnik D, Sulzenko J, van Zwam W, Gruber A, Ribo M, Cognard C, Szikora I, Flodmark O, Widimsky P. Interdisciplinary management of acute ischaemic stroke: Current evidence training requirements for endovascular stroke treatment. Position Paper from the ESC Council on Stroke and the European Association for Percutaneous Cardiovascular Interventions with the support of the European Board of Neurointervention. Eur Heart J 2021; 42:298-307. [PMID: 33521827 DOI: 10.1093/eurheartj/ehaa833] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/07/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022] Open
Abstract
This ESC Council on Stroke/EAPCI/EBNI position paper summarizes recommendations for training of cardiologists in endovascular treatment of acute ischaemic stroke. Interventional cardiologists adequately trained to perform endovascular stroke interventions could complement stroke teams to provide the 24/7 on call duty and thus to increase timely access of stroke patients to endovascular treatment. The training requirements for interventional cardiologists to perform endovascular therapy are described in details and should be based on two main principles: (i) patient safety cannot be compromised, (ii) proper training of interventional cardiologists should be under supervision of and guaranteed by a qualified neurointerventionist and within the setting of a stroke team. Interdisciplinary cooperation based on common standards and professional consensus is the key to the quality improvement in stroke treatment.
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Affiliation(s)
- Sandor Nardai
- Department Section of Neurointervention, National Institute of Clinical Neurosciences, Semmelweis University Heart and Vascular Center and Semmelweis University, Budapest, Hungary
| | - Peter Lanzer
- Mitteldeutsches Herzzentrum, Standort Bitterfeld-Wolfen, Germany
| | - Mark Abelson
- Vergelegen MediClinic, Somerset West, University of Cape Town, South Africa
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), and Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, and Center for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
| | - L Nelson Hopkins
- Gates Vascular Institute and Jacobs Institute, Neurosurgery and Radiology, University at Buffalo, USA
| | - Jan Kovac
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Marco Roffi
- Division of cardiology, University Hospitals, Geneva, Switzerland
| | - Horst Sievert
- CardioVascular Center Frankfurt, Germany and Anglia Ruskin University, Chelmsford, UK
| | - Dmitry Skrypnik
- Department of Interventional Cardiology, Moscow Hospital I. Davydovsky and Moscow State University of Medicine and Dentistry, Russian Federation
| | - Jakub Sulzenko
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Wim van Zwam
- Department of Radiology and Nuclear Medicin, Academic Hospital of Maastricht, Maastricht, The Netherlands
| | - Andreas Gruber
- Universitätsklinik für Neurochirurgie, Kepler Universitäts Klinikum, Linz, Austria
| | - Marc Ribo
- Department of Neurology, Hospital Wall d'Hebron, Barcelona, Spain
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology Hôpital Purpan, Toulouse, France
| | - Istvan Szikora
- Department Section of Neurointervention, National Institute of Clinical Neurosciences, Semmelweis University, Budapest, Hungary
| | - Olof Flodmark
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Endovascular revascularization of chronically occluded vertebral artery: single-center experience. Wideochir Inne Tech Maloinwazyjne 2021; 16:211-218. [PMID: 33786136 PMCID: PMC7991923 DOI: 10.5114/wiitm.2020.97445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/14/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Chronic vertebral basilar artery occlusion is one of the most common causes of ischemic stroke, which accounts for roughly 20% of all cases. However, the evidence for the precise clinical effect in treatment of the initial segment of chronic vertebral basilar artery occlusion is not sufficient. Aim To evaluate the feasibility and efficacy of endovascular therapy in the initial segment of chronic vertebral basilar artery occlusion. Material and methods This is a retrospective study based on data obtained from Lishui Hospital of Zhejiang University. We identified patients who underwent treatment for initial segment occlusion of the vertebral basilar artery from September 2014 to September 2018. Results Among a total of twenty-two subjects, 77.27% of them were men and the median age was 61 years old. The primary medical history of these patients included hypertension (15, 68.18%), hyperlipidemia (13, 59.09%), diabetes mellitus (11, 50.00%), and coronary artery disease (6, 27.27%). About 54.54% of the patients were current smokers. Successful recanalization was achieved in 86.36% of patients. Five cases of balloon dilatation were recanalized and fourteen cases were treated by balloon dilation combined with stent implantation. During the follow-up period, there were no recurrent cerebral ischemic events, including transient ischemic attack or stroke. Six (27.27%) arteries were found to exhibit angiographic re-stenosis. Conclusions The clinical effect of balloon dilatation or balloon dilatation combined with stenting in the treatment of chronic vertebral basilar artery occlusion in the beginning segment was feasible and safe.
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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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Carvalho de Campos Martins E, Luiz de Melo Bernardi F, Maia Junior OT, Micari A, Hopkins LN, Cremonesi A, Castriota F. Similarities and Differences Between Primary Percutaneous Coronary Intervention and Mechanical Thrombectomy. JACC Cardiovasc Interv 2021; 13:1683-1696. [PMID: 32703592 DOI: 10.1016/j.jcin.2020.03.055] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 02/06/2023]
Abstract
Acute ischemic stroke is among the leading causes of mortality and disability worldwide. Since 2015, as was the case for primary percutaneous coronary intervention for acute myocardial infarction, catheter-based reperfusion via mechanical thrombectomy (MT) has become the gold-standard treatment for acute ischemic stroke caused by large-vessel occlusion. Despite that, only a fraction of the world's population currently would be able to undergo MT in time, mostly because of the scarcity of 24/7 coverage by neurointerventionalists to deal with this enormous burden. Interventional cardiologists have thus been considered a logical option to aid in combating this vast demand to diminish the burden of acute ischemic stroke. However, despite some seemingly evident similarities between primary percutaneous coronary intervention and MT, for interventional cardiologists to enter this new field, they must be well trained and fully aware of all the clinical, technical, and environmental differences between these two scenarios. The main objective of this state-of-the-art paper is to serve as an introductory and comprehensive guide to familiarize the interventional cardiology community with the most critical technical aspects of MT.
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Affiliation(s)
| | | | | | - Antonio Micari
- Cardiovascular Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy
| | - Leo Nelson Hopkins
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Jacobs Institute, Buffalo, New York
| | | | - Fausto Castriota
- Cardiovascular Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy
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Reperfusion strategies in stroke due to isolated cervical internal carotid artery occlusion: systematic review and treatment comparison. Neurol Sci 2020; 42:2301-2308. [PMID: 33037515 PMCID: PMC8159826 DOI: 10.1007/s10072-020-04735-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/17/2020] [Indexed: 01/18/2023]
Abstract
Introduction Despite intravenous thrombolysis (IVT) and endovascular treatment (EVT) have been demonstrated effective in acute ischemic stroke (AIS) due to large vessel occlusions, there are still no conclusive data to guide treatment in stroke due to cervical internal carotid artery (ICA) occlusion. We systematically reviewed available literature to compare IVT, EVT, and bridging (IVT + EVT) and define optimal treatment. Methods Systematic review followed predefined protocol (Open-Science-Framework osf.io/bfykj). MEDLINE, EMBASE, and Cochrane CENTRAL were searched. Results were restricted to studies in English, with sample size ≥ 10 and follow-up ≥30 days. Primary outcomes were favorable outcome (mRS ≤ 2), mortality, and symptomatic intracerebral hemorrhage(sICH), defined according to study original report. Newcastle-Ottawa scale was used for bias assessment. Results Seven records of 930 screened were included in meta-analysis. Quality of studies was low-to-fair in 5, good in 2. IVT (n = 450) did not differ for favorable outcome and mortality compared to EVT (n = 150), though having lower rate of sICH (OR = 0.4, 95% CI 0.2–0.8). Compared to IVT, bridging (IVT + EVT) was associated with higher rate of favorable outcome (OR = 2.2, 95% CI 1.3–3.7). Compared to EVT, bridging (IVT + EVT) provided higher rate of favorable outcome (OR = 1.9, 95% CI 1.1–3.4), with a marginally increased risk of sICH (OR = 2.1, 95% CI 1–4.4) but similar mortality rates. Conclusions Our systematic review highlights that, in acute ischemic stroke associated with isolated cervical ICA occlusion, bridging (IVT + EVT) might lead to higher rate of functional independence at follow-up, without increasing mortality. The low quality of available studies prevents from drawing firm conclusions, and randomized-controlled clinical trials are critically needed to define optimal treatment in this AIS subgroup. Electronic supplementary material The online version of this article (10.1007/s10072-020-04735-5) contains supplementary material, which is available to authorized users.
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Geographic Disparities in the Treatment of Acute Stroke and the Role of Interventional Cardiologists. JACC Cardiovasc Interv 2020; 13:892-894. [DOI: 10.1016/j.jcin.2020.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 11/22/2022]
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14
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Patients, Practice, Practicality, and Politics. JACC Cardiovasc Interv 2019; 12:1711-1713. [DOI: 10.1016/j.jcin.2019.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 06/18/2019] [Indexed: 01/03/2023]
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15
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Acute Stroke Interventions Performed by Cardiologists. JACC Cardiovasc Interv 2019; 12:1703-1710. [DOI: 10.1016/j.jcin.2019.05.052] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 11/22/2022]
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Vizzari G, Versaci F, Nicosia A. Percutaneous treatments of acute myocardial infarction and major stroke: Two parallel roads. JRSM Cardiovasc Dis 2019; 8:2048004019869162. [PMID: 31452876 PMCID: PMC6700859 DOI: 10.1177/2048004019869162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 06/26/2019] [Accepted: 07/18/2019] [Indexed: 11/16/2022] Open
Abstract
Neurological and cardiovascular ischemic diseases represent the main causes of morbidity and mortality in the world. Physiopathological mechanisms present several similarities, based on "thromboembolic" events, as well as the pharmacological and percutaneous treatment options. We report a case of contemporary presentation of acute coronary and cerebral syndromes, successfully managed with a combined percutaneous intervention driven by the emergency setting. Whereas invasive revascularization represents nowadays the "gold standard" therapy for acute coronary syndromes, catheter-based treatment of acute stroke is not yet widespread and still under debate.
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Affiliation(s)
- Giampiero Vizzari
- Cardiology Unit, "Giovanni Paolo II" Hospital of Ragusa, Ragusa, Italy.,Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Versaci
- Cardiology Unit, "Santa Maria Goretti" Hospital, Latina, Italy.,Dipartimento di Scienze Mediche, Tor Vergata University of Rome, Rome, Italy
| | - Antonino Nicosia
- Cardiology Unit, "Giovanni Paolo II" Hospital of Ragusa, Ragusa, Italy
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Nicosia A, Cernetti C, Cremonesi A, Goktekin O, Sauguet A, Wijns W, Musumeci G. PCR Peripheral @ GISE: a unique educational link between peripheral endovascular solutions and interventional cardiologists. EUROINTERVENTION 2017; 13:e1013-e1017. [PMID: 29033385 DOI: 10.4244/eijv13i9a154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Marton-Popovici M. Review. Regional Networks in Acute Cardiac Care. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
In acute cardiac care, the timely initiation of life-saving measures proved to be life-saving and requires many organizational and logistic measures. One of such measures is represented by the development and implementation of a regional network dedicated for the treatment of major cardiovascular emergencies, a strategy that proved to significantly reduce mortality rates on short and long term. This review aims to describe the current status in the development of regional networks in three of the main cardiovascular emergencies: acute myocardial infarction, out-of-hospital cardiac arrest, and acute stroke. The concepts demonstrating the utility of such networks, together with their results in reducing cardiac events, are presented in this paper.
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Affiliation(s)
- Monica Marton-Popovici
- Swedish Medical Center, Department of Internal Medicine and Critical Care, Edmonds, Washington , USA
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