Endovascular treatment for acute ischemic stroke at a primary stroke center: First results of the Perpignan center

Background Patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) were usually transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (drip-and-ship [DS]), while driving the doctor from a CSC to a PSC to perform a procedure is an alternative strategy (drip-and-drive [DD]). Purpose To compare the efficacy and prognosis of the two strategies. Material and Methods From February 2017 to June 2019, 62 patients with LVO received endovascular treatment via the DS and DD models and were retrospectively analyzed from the stroke alliance based on our CSC. Primary endpoint was door-to-reperfusion (DTR) time. Secondary endpoints included puncture-to-recanalization (PTR) time, modified Thrombolysis in Cerebral Infarction (mTICI) rates at the end of the procedure, and modified Rankin Scale (mRS) at 90 days. Results Forty-one patients received the DS strategy and 21 patients received the DD strategy. The DTR time was significantly longer in the DS group compared to the DD group (315.5 ± 83.8 min vs. 248.6 ± 80.0 min; P < 0.05), and PTR time was shorter (77.2 ± 35.9 min vs. 113.7 ± 69.7 min; P = 0.033) compared with the DD group. Successful recanalization (mTICI 2b/3) was achieved in 89% (36/41) of patients in the DS group and 86% (18/21) in the DD group ( P = 1.000). Favorable functional outcomes (mRS 0–2) were observed in 49% (20/41) of patients in the DS group and 71% (15/21) in the DD group at 90 days ( P = 0.089). Conclusion Compared with the DS strategy, the DD strategy showed more effective and a trend of better clinical outcomes for AIS patients with LVO.

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Effect of Interhospital Transfer on Endovascular Treatment for Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.118.024091 ◽

2019 ◽

Vol 50 (4) ◽

pp. 923-930 ◽

Cited By ~ 21

Author(s):

Esmee Venema ◽

Adrien E. Groot ◽

Hester F. Lingsma ◽

Wouter Hinsenveld ◽

Kilian M. Treurniet ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

Functional Independence ◽

Modified Rankin Scale ◽

Interhospital Transfer ◽

Primary Stroke Center ◽

Transferred Patients ◽

Stroke Center

Background and Purpose— To assess the effect of inter-hospital transfer on time to treatment and functional outcome after endovascular treatment (EVT) for acute ischemic stroke, we compared patients transferred from a primary stroke center to patients directly admitted to an intervention center in a large nationwide registry. Methods— MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry is an ongoing, prospective, observational study in all centers that perform EVT in the Netherlands. We included adult patients with an acute anterior circulation stroke who received EVT between March 2014 to June 2016. Primary outcome was time from arrival at the first hospital to arterial groin puncture. Secondary outcomes included the 90-day modified Rankin Scale score and functional independence (modified Rankin Scale score of 0–2). Results— In total 821/1526 patients, (54%) were transferred from a primary stroke center. Transferred patients less often had prestroke disability (227/800 [28%] versus 255/699 [36%]; P =0.02) and more often received intravenous thrombolytics (659/819 [81%] versus 511/704 [73%]; P <0.01). Time from first presentation to groin puncture was longer for transferred patients (164 versus 104 minutes; P <0.01, adjusted delay 57 minutes [95% CI, 51–62]). Transferred patients had worse functional outcome (adjusted common OR, 0.75 [95% CI, 0.62–0.90]) and less often achieved functional independence (244/720 [34%] versus 289/681 [42%], absolute risk difference −8.5% [95% CI, −8.7 to −8.3]). Conclusions— Interhospital transfer of patients with acute ischemic stroke is associated with delay of EVT and worse outcomes in routine clinical practice, even in a country where between-center distances are short. Direct transportation of patients potentially eligible for EVT to an intervention center may improve functional outcome.

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Abstract P145: Outcomes of an EMR-Enabled Acute Ischemic Stroke Care Path in a Primary Stroke Center

Circulation ◽

10.1161/circ.139.suppl_1.p145 ◽

2019 ◽

Vol 139 (Suppl_1) ◽

Author(s):

Aaron Dunn ◽

Selena Pasadyn ◽

Francis May ◽

Dolora Wisco

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Care ◽

Primary Stroke Center ◽

Stroke Center ◽

Care Path

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Emergency Medical Services Support for Acute Ischemic Stroke Patients Receiving Thrombolysis at a Primary Stroke Center

Journal of brain disease ◽

10.4137/jcnsd.s2221 ◽

2009 ◽

Vol 1 ◽

pp. JCNSD.S2221

Author(s):

Byron R. Spencer ◽

Omar M. Khan ◽

Bentley J. Bobrow ◽

Bart M. Demaerschalk

Keyword(s):

Decision Making ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Onset ◽

Stroke Patients ◽

Emergency Medical ◽

Field Assessment ◽

Primary Stroke Center ◽

Stroke Center

Background Emergency Medical Services (EMS) is a vital link in the overall chain of stroke survival. A Primary Stroke Center (PSC) relies heavily on the 9-1-1 response system along with the ability of EMS personnel to accurately diagnose acute stroke. Other critical elements include identifying time of symptom onset, providing pre-hospital care, selecting a destination PSC, and communicating estimated time of arrival (ETA). Purpose Our purpose was to evaluate the EMS component of thrombolysed acute ischemic stroke patient care at our PSC. Methods In a retrospective manner we retrieved electronic copies of the EMS incident reports for every thrombolysed ischemic stroke patient treated at our PSC from September 2001 to August 2005. The following data elements were extracted: location of victim, EMS agency, times of dispatch, scene, departure, emergency department (ED) arrival, recordings of time of stroke onset, blood pressure (BP), heart rate (HR), cardiac rhythm, blood glucose (BG), Glasgow Coma Scale (GCS), Cincinnati Stroke Scale (CSS) elements, emergency medical personnel field assessment, and transport decision making. Results Eighty acute ischemic stroke patients received thrombolysis during the study interval. Eighty-one percent arrived by EMS. Two EMS agencies transported to our PSC. Mean dispatch-to-scene time was 6 min, on-scene time was 16 min, transport time was 10 min. Stroke onset time was recorded in 68%, BP, HR, and cardiac rhythm each in 100%, BG in 81%, GCS in 100%, CSS in 100%, and acute stroke diagnosis was made in 88%. Various diagnostic terms were employed: cerebrovascular accident in 40%, unilateral weakness or numbness in 20%, loss of consciousness in 16%, stroke in 8%, other stroke terms in 4%. In 87% of incident reports there was documentation of decision-making to transport to the nearest PSC in conjunction with pre-notification. Conclusion The EMS component of thrombolysed acute ischemic stroke patients care at our PSC appeared to be very good overall. Diagnostic accuracy was excellent, field assessment, decision-making, and transport times were very good. There was still room for improvement in documentation of stroke onset and in employment of a common term for acute stroke.

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Rescue Therapy in Endovascualr Treatment for Acute Ischemic Stroke Due to Large Artery Atherosclerosis

10.21203/rs.2.18952/v1 ◽

2019 ◽

Author(s):

Mingli Liu ◽

Minghui Chen ◽

Yang Liu ◽

Lin Lin ◽

Yongli Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Rescue Therapy ◽

Large Artery ◽

Procedure Time ◽

Excellent Outcome ◽

Logistic Analysis ◽

Tandem Occlusion ◽

Stroke Center

Abstract Background and purpose Safety and predictors of rescue therapy in patients with acute ischemic stroke due to large artery atherosclerosis still remain unclear. This study aimed to test safety of rescue therapy and evaluate predictors of it after failed mechanical thrombectomy.Methods This retrospective study enrolled consecutively 245 patients with acute ischemic stroke treated by endovascular treatment from March 2016 to April 2019 in a single stroke center. We analyzed the clinical data and laboratory test for safety and predictors of rescue therapy. Binary logistic analysis was applied to confirm the independently relationship.Results There were totally 145 patients enrolled among 245 patients. Rescue therapy was independently associated with the excellent outcome [p=0.048, adjusted OR: 2.655, 95%CI: 1.008 – 6.989] and longer procedure time of endovascular treatment [p=0.004, adjusted OR: 3.722, 95%CI: 1.519-9.122], but there was no significance on complications and mortality. Prestrike incidence [p=0.004, adjusted OR:4.427, 95%CI:1.618-12.114], use of rt-PA [p=0.003, adjusted OR:4.792, 95%CI:1.688-13.602], tandem occlusion [p=0.001, adjusted OR:0.021, 95%CI:0.002-0.194], PLT [p=0.012, adjusted OR:3.234, 95%CI:1.289-8.113], P-LCR>42.3% [p=0.031, adjusted OR:0.132, 95%CI:0.021-0.827] were independent predictors of rescue therapy.Conclusions Rescue therapy for acute ischemic stroke due to large artery atherosclerosis costs more procedure time of endovascular treatment, but it can successfully recanalize the occlusive large artery and is independently related to the excellent clinical outcome without increasing ICH, sICH, reocclusion and others. Prestroke incidence, use of rt-PA, tandem occlusion, PLT and P-LCR may be independent predictors of rescue therapy in acute ischemic stroke due to large artery atherosclerosis.

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TRIAGE-STROKE: Treatment strategy In Acute larGE vessel occlusion: Prioritize IV or endovascular treatment—A randomized trial

International Journal of Stroke ◽

10.1177/1747493019869830 ◽

2019 ◽

Vol 15 (1) ◽

pp. 103-108 ◽

Cited By ~ 1

Author(s):

Anne Behrndtz ◽

Søren P Johnsen ◽

Jan B Valentin ◽

Martin F Gude ◽

Rolf A Blauenfeldt ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Hospital Setting ◽

Intravenous Thrombolysis ◽

Large Vessel ◽

Stroke Severity ◽

Study Results ◽

Primary Stroke Center ◽

Stroke Center

Rationale For patients with acute ischemic stroke and large vessel occlusions, intravenous thrombolysis and endovascular therapy are standard of care, but the effect of endovascular therapy is superior to intravenous thrombolysis. If a severe stroke with symptoms indicating large vessel occlusions occurs in the catchment area of a primary stroke center, there is equipoise regarding optimal transport strategy. Aim For patients presenting with suspected large vessel occlusions (PASS ≥ 2) and a final diagnosis of acute ischemic stroke, we hypothesize that bypassing the primary stroke center will result in an improved 90-day functional outcome. Sample size We aim to randomize 600 patients, 1:1. Design A national investigator-driven, multi-center, randomized assessor-blinded clinical trial. The Prehospital Acute Stroke Severity Scale has been developed. It identifies most patients with large vessel occlusions in the pre-hospital setting. Patients without a contraindication for intravenous thrombolysis are randomized to either transport directly to a comprehensive stroke centers for intravenous thrombolysis and of endovascular therapy or to a primary stroke center for intravenous thrombolysis and subsequent transport to a comprehensive stroke centers for of endovascular therapy, if needed. Outcomes The primary outcome will be the 90-day modified Rankin Scale score (mRS) for all patients with acute ischemic stroke. Secondary outcomes include 90-day mRS for all randomized patients, all patients with ischemic stroke but without large vessel occlusions, and patients with hemorrhagic stroke. The safety outcomes include severe dependency or death and time to intravenous thrombolysis for ischemic stroke patients. Discussion Study results will influence decision making regarding transport strategy for patients with suspected large vessel occlusions.

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Abstract P292: Characteristics of Asian Americans With Acute Ischemic Stroke Treated at a Tertiary/Quaternary Stroke Center

Stroke ◽

10.1161/str.52.suppl_1.p292 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Claude Nguyen ◽

David Grosvenor ◽

Ilana Spokoyny ◽

Charlene Chen ◽

Christine S Wong ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

San Francisco ◽

Asian Americans ◽

Asian American ◽

Similar Proportion ◽

Chi Square ◽

Stroke Center ◽

To Receive

Background: Asian Americans comprise a rapidly increasing segment of the population, but little is known of their outcomes after acute ischemic stroke. We compared Asians and whites presenting to a San Francisco Bay Area tertiary/quaternary stroke center that uniquely serves a high proportion of Asian American patients, and reviewed the treatment rates and outcomes of Asian Americans presenting with acute ischemic stroke compared to whites. Methods: We performed a retrospective study of ischemic stroke patients presenting to our center between 1/2014-7/2020, conducting univariate analyses of demographics, comorbidities, and clinical outcomes in those designated as Asian compared with white patients. Odds ratios and chi-square analyses were conducted between groups. Asians were defined as those of Asian Indian, Chinese, Filipino, Japanese, Korean, or Vietnamese descent. Results: Between 1/2014 and 7/2020, 3958 patients presented with ischemic stroke; 852 (21.5%) were Asian and 2107 (53.2%) were white. Asians were older and more likely to have hypertension, hyperlipidemia, and diabetes, and less likely to have atrial fibrillation (Table 1). More Asians presented directly to our center, while more whites were transferred in. IV rt-PA rates are described in Table 1. Overall, Asians were less likely to receive endovascular treatment (Table 1). Asians had a higher NIHSS at discharge, although there was no difference in the proportion who expired or who were discharged home. Conclusions: Asians with ischemic stroke tended to have more comorbid conditions than whites. Though there was a trend towards similar IV rt-PA rates between Asians and whites presenting to the ED, Asians were less likely to receive endovascular treatment, and had worse NIHSS on discharge with similar proportion going home. This may have to do with local geographic/socioeconomic distribution, or differences in stroke etiology. Further analyses are needed to better elucidate these disparities.

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Comparison of Performance Achievement Award Recognition With Primary Stroke Center Certification for Acute Ischemic Stroke Care

Journal of the American Heart Association ◽

10.1161/jaha.113.000451 ◽

2013 ◽

Vol 2 (5) ◽

Cited By ~ 13

Author(s):

Gregg C. Fonarow ◽

Li Liang ◽

Eric E. Smith ◽

Mathew J. Reeves ◽

Jeffrey L. Saver ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Care ◽

Performance Achievement ◽

Achievement Award ◽

Primary Stroke Center ◽

Stroke Center

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Differences in Acute Ischemic Stroke Quality of Care and Outcomes by Primary Stroke Center Certification Organization

Stroke ◽

10.1161/strokeaha.116.014426 ◽

2017 ◽

Vol 48 (2) ◽

pp. 412-419 ◽

Cited By ~ 25

Author(s):

Shumei Man ◽

Margueritte Cox ◽

Puja Patel ◽

Eric E. Smith ◽

Mathew J. Reeves ◽

...

Keyword(s):

Ischemic Stroke ◽

Quality Of Care ◽

Acute Ischemic Stroke ◽

Primary Stroke Center ◽

Stroke Center

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The association between computed tomography angiography timing and workflow times in patients with acute ischemic stroke

International Journal of Stroke ◽

10.1177/1747493020962236 ◽

2020 ◽

pp. 174749302096223

Author(s):

Femke M Dessens ◽

Adrien E Groot ◽

Bas van der Veen ◽

Kilian M Treurniet ◽

Charles BLM Majoie ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Confidence Interval ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Computed Tomography Angiography ◽

Intravenous Thrombolysis ◽

Median Difference ◽

Adjusted Analysis ◽

Stroke Center

Background In most hospitals, computed tomography angiography (CTA) is nowadays routinely performed in patients with acute ischemic stroke. However, it is unclear whether CTA is best performed before or after start of intravenous thrombolysis (IVT), since acquisition of CTA before IVT may prolong door-to-needle times, while acquisition after IVT may prolong door-to-groin times in patients undergoing endovascular treatment. Methods We performed a before-versus-after study (CTA following IVT, period I and CTA prior to IVT, period II), consisting of two periods of one year each. This study is based on a prospective registry of consecutive patients treated with IVT in two collaborating high-volume stroke centers; one primary stroke center and one comprehensive stroke center. The primary outcome was door-to-needle times. Secondary outcomes included door-to-groin times. Quantile regression analyses were performed to evaluate the association between timing of CTA and workflow times, adjusted for prognostic factors. Results A total of 519 patients received IVT during the study period (246 in period I, 273 in period II). In the adjusted analysis, we found a nonsignificant 1.13 min median difference in door-to-needle times (95% confidence interval: 1.03–3.29). Door-to-groin times was significantly shorter in period II in both unadjusted and adjusted analysis with the latter showing a 19.16 min median difference (95% confidence interval: 3.08–35.24). Conclusions CTA acquisition prior to start of IVT did not adversely affect door-to-needle times. However, a significantly shorter door-to-groin times was observed in endovascular treatment eligible patients. Performing CTA prior to start of IVT seems the preferred strategy.

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