scholarly journals Pediatric Thrombectomy

Stroke ◽  
2021 ◽  
Author(s):  
David C. Lauzier ◽  
Maria M. Galardi ◽  
Kristin P. Guilliams ◽  
Manu S. Goyal ◽  
Catherine Amlie-Lefond ◽  
...  
Keyword(s):  
Stroke Care ◽  
Hospital Environment ◽  
Pediatric Stroke ◽  
Design Features ◽  
Endovascular Thrombectomy ◽  
Similar Role ◽  
Stroke Imaging ◽  
Workflow Integration

Endovascular thrombectomy has played a major role in advancing adult stroke care and may serve a similar role in pediatric stroke care. However, there is a need to develop better evidence and infrastructure for pediatric stroke care. In this work, we review 2 experienced pediatric endovascular thrombectomy programs and examine key design features in both care environments, including a formalized protocol and workflow, integration with an adult endovascular thrombectomy workflow, simplification and automation of workflow steps, pediatric adaptations of stroke imaging, advocacy of pediatric stroke care, and collaboration between providers, among others. These essential features transcend any single hospital environment and may provide an important foundation for other pediatric centers that aim to enhance the care of children with stroke.

Abstract P589: Pediatric Thrombectomy: Design And Workflow Lessons From Two Experienced Centers

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
David C Lauzier ◽  
Maria M Galardi ◽  
Kristin Guilliams ◽  
Manu S Goyal ◽  
Catherine Amlie-Lefond ◽  
...  
Keyword(s):  
Case Reports ◽  
Quality Care ◽  
Stroke Care ◽  
Outcome Data ◽  
Hospital Environment ◽  
Pediatric Stroke ◽  
Endovascular Thrombectomy ◽  
Stroke Imaging ◽  
Workflow Integration ◽  
Low Incidence

Introduction: While clinical trials have demonstrated the remarkable efficacy of endovascular thrombectomy (EVT) for treating adult patients suffering from acute ischemic stroke (AIS), benefits reaped from advances in adult stroke care have unfortunately not occurred in parallel with pediatric stroke care. Randomized trials of EVT in childhood stroke are unlikely given the low incidence of stroke in children compared to adults, and despite promising outcomes in small case reports and series, EVT in children remains an off-label procedure lacking established consensus guidelines. Along with a clear need to collect prospective pediatric EVT outcome data, there is a need to enhance pediatric stroke care infrastructure to provide high-quality care to children experiencing stroke. Methods: In this work, we review two successful pediatric thrombectomy programs, examining key workflow design features that are likely to be important for other programs that aspire to implement pediatric EVT capability. Discussion: While pediatric EVT workflows will vary between centers, we identify several key elements of programmatic success shared between the two reviewed stroke programs that may serve as foundational design considerations for centers aiming to develop their own pediatric EVT programs. These elements include a formalized protocol and workflow, integration with an adult EVT workflow, simplification and automation of workflow steps, pediatric adaptations of stroke imaging, advocacy of pediatric stroke care, and collaboration between providers, among others. These essential features transcend any single hospital environment and may provide an important foundation for other pediatric centers that aim to enhance the care of children with stroke. Conclusion: EVT shows promise in reducing stroke-associated morbidity in children. To maximize the efficacy of this intervention, workflow optimizations discussed here should be implemented by centers seeking to develop local pediatric EVT capability.

scholarly journals Stroke Care During the First and the Second Waves of the COVID-19 Pandemic in a Community Hospital

2021 ◽  
Vol 12 ◽  
Author(s):  
Piotr Sobolewski ◽  
Wiktor Szczuchniak ◽  
Danuta Grzesiak-Witek ◽  
Jacek Wilczyński ◽  
Karol Paciura ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Stroke Unit ◽  
Community Hospital ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Staff Members ◽  
Second Wave

Objective: The coronavirus disease 2019 (COVID-19) infection may alter a stroke course; thus, we compared stroke course during subsequent pandemic waves in a stroke unit (SU) from a hospital located in a rural area.Methods: A retrospective study included all patients consecutively admitted to the SU between March 15 and May 31, 2020 (“first wave”), and between September 15 and November 30, 2020 (“second wave”). We compared demographic and clinical data, treatments, and outcomes of patients between the first and the second waves of the pandemic and between subjects with and without COVID-19.Results: During the “first wave,” 1.4% of 71 patients were hospitalized due to stroke/TIA, and 41.8% of 91 during the “second wave” were infected with SARS-CoV-2 (p < 0.001). During the “second wave,” more SU staff members were infected with COVID-19 than during the “first wave” (45.6 vs. 8.7%, p < 0.001). Nevertheless, more patients underwent intravenous thrombolysis (26.4 vs. 9.9%, p < 0.008) and endovascular thrombectomy (5.3 vs. 0.0%, p < 0.001) during the second than the first wave. Large vessel occlusion (LVO) (OR 8.74; 95% CI 1.60–47.82; p = 0.012) and higher 30-day mortality (OR 6.01; 95% CI 1.04–34.78; p = 0.045) were associated with patients infected with COVID-19. No differences regarding proportions between ischemic and hemorrhagic strokes and TIAs between both waves or subgroups with and without COVID-19 existed.Conclusion: Despite the greater COVID-19 infection rate among both SU patients and staff during the “second wave” of the pandemic, a higher percentage of reperfusion procedures has been performed then. COVID-19 infection was associated with a higher rate of the LVO and 30-day mortality.

Abstract WP394: Impact of MRI/A versus CTA/P versus Direct Angiosuite Triage Protocols in Stroke Care Performance and Outcome of Transferred Patients for Endovascular Thrombectomy

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Santiago Ortega-Gutierrez ◽  
Andrea Holcombe ◽  
Gloria Lopez-Cardenas ◽  
Helin Hernandez ◽  
Binbin Zheng-Lin ◽  
...  
Keyword(s):  
Stroke Care ◽  
Endovascular Thrombectomy ◽  
Transferred Patients ◽  
Care Performance

scholarly journals The Cost of Pediatric Stroke Care and Rehabilitation

Stroke ◽  
2008 ◽  
Vol 39 (1) ◽  
pp. 161-165 ◽  
Author(s):  
Warren Lo ◽  
Khaled Zamel ◽  
Kavita Ponnappa ◽  
Antoni Allen ◽  
Deena Chisolm ◽  
...  
Keyword(s):  
Stroke Care ◽  
Pediatric Stroke ◽  
The Cost

Economic evaluation of the Melbourne Mobile Stroke Unit

2020 ◽  
pp. 174749302092994 ◽  
Author(s):  
Joosup Kim ◽  
Damien Easton ◽  
Henry Zhao ◽  
Skye Coote ◽  
Garveeta Sookram ◽  
...  
Keyword(s):  
Stroke Unit ◽  
Standard Care ◽  
Stroke Care ◽  
Reperfusion Therapy ◽  
Sensitivity Analyses ◽  
Local Data ◽  
Endovascular Thrombectomy ◽  
Stroke Treatment ◽  
Mobile Stroke Unit ◽  
Life Years

Background The Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy. Aims To estimate the cost-effectiveness of the MSU during the first full year of operation compared with standard ambulance and hospital stroke care pathways (standard care). Methods The costs and benefits of the Melbourne MSU were estimated using an economic simulation model. Operational costs and service utilization data were obtained from the MSU financial and patient tracking reports. The health benefits were estimated as disability-adjusted life years (DALYs) avoided using local data on reperfusion therapy and estimates from the published literature on their effectiveness. Costs were presented in Australian dollars. The robustness of results was assessed using multivariable (model inputs varied simultaneously: 10,000 Monte Carlo iterations) and various one-way sensitivity analyses. Results In 2018, the MSU was dispatched to 1244 patients during 200 days of operation. Overall, 167 patients were diagnosed with acute ischemic stroke, and 58 received thrombolysis, endovascular thrombectomy, or both. We estimated 27.94 DALYs avoided with earlier access to endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93) and 16.90 DALYs avoided with improvements in access to thrombolysis (95% CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982 per DALY avoided (95% CI $21,142 to $47,517) compared to standard care. Conclusions There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.

scholarly journals Diagnosis and management of acute ischaemic stroke

2020 ◽  
Vol 20 (4) ◽  
pp. 304-316 ◽  
Author(s):  
Robert Hurford ◽  
Alakendu Sekhar ◽  
Tom A T Hughes ◽  
Keith W Muir
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Neuronal Damage ◽  
Early Recognition ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Close Monitoring ◽  
Endovascular Thrombectomy ◽  
Early Neurological Deterioration ◽  
Ischaemic Penumbra

Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients should be admitted directly to an acute stroke unit for close monitoring for early neurological deterioration and prevention of secondary complications. Prompt investigation of the mechanism of stroke allows patients to start appropriate secondary preventative treatment. Future objectives include improving accessibility to endovascular thrombectomy, using advanced imaging to extend therapeutic windows and developing neuroprotective agents to prevent secondary neuronal damage.

Studying Stroke Thrombus Composition After Thrombectomy: What Can We Learn?

Stroke ◽  
2021 ◽  
Author(s):  
Senna Staessens ◽  
Olivier François ◽  
Waleed Brinjikji ◽  
Karen M. Doyle ◽  
Peter Vanacker ◽  
...  
Keyword(s):  
Endovascular Procedures ◽  
Stroke Care ◽  
Lessons Learned ◽  
Success Rates ◽  
Complex Composition ◽  
Comprehensive Overview ◽  
Endovascular Thrombectomy ◽  
Extracellular Traps ◽  
Von Willebrand ◽  
Willebrand Factor

The composition of ischemic stroke thrombi has gained an increasing amount of interest in recent years. The implementation of endovascular procedures in standard stroke care has granted researchers the unique opportunity to examine patient thrombus material. Increasing evidence indicates that stroke thrombi are complex and heterogenous, consisting of various biochemical (eg, fibrin, von Willebrand factor, and neutrophil extracellular traps) and cellular (eg, red blood cells, platelets, leukocytes, and bacteria) components. This complex composition may explain therapeutic limitations and also offer novel insights in several aspects of stroke management. Better understanding of thrombus characteristics could, therefore, potentially lead to improvements in the management of patients with stroke. In this review, we provide a comprehensive overview of the lessons learned by examining stroke thrombus composition after endovascular thrombectomy and its potential relevance for thrombectomy success rates, thrombolysis, clinical outcomes, stroke etiology, and radiological imaging.

Risk factors and outcomes of intravenous tissue plasminogen activator and endovascular thrombectomy utilization amongst pediatrics acute ischemic stroke

2020 ◽  
pp. 174749302090491
Author(s):  
Preeti Malik ◽  
Urvish K Patel ◽  
Surabhi Kaul ◽  
Ramit Singla ◽  
Tapan Kavi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Pediatric Stroke ◽  
Endovascular Thrombectomy ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Background Pediatric stroke is a debilitating disease. There are several risk factors predisposing children to this life-threatening disease. Although, published literature estimates a relatively high incidence of pediatric stroke, treatment guidelines on intravenous tissue plasminogen activator and endovascular thrombectomy utilization remain a dilemma. There is a lack of large population-based studies and clinical trials evaluating the efficacy and safety outcomes associated with these treatments in this unique population. Aim We sought to determine the prevalence of risk factors, concurrent utilization of intravenous tissue plasminogen activator and endovascular thrombectomy, and associated outcomes in pediatric stroke hospitalizations. Methods We performed a retrospective analysis of the Nationwide Inpatient Sample data (2003–2014) in pediatric (1–21 years of age) acute ischemic stroke hospitalizations using ICD-9-CM codes. The multivariable survey logistic regression model was weighted to account for sampling strategy, evaluate predictors of hemorrhagic conversion, and treatment outcomes (mortality, morbidity, and discharge disposition) amongst pediatric stroke hospitalizations. Results In this analysis, 9109 patients between 1 and 21 years of age were admitted during 2003–2014 for acute ischemic stroke. Of these 9109 patients, 119 (1.30%) received endovascular thrombectomy alone, 256 (2.82%) intravenous recombinant tissue plasminogen activator, and 69 (0.75%) both endovascular thrombectomy and intravenous recombinant tissue plasminogen activator. We found overall high prevalence of conditions like epilepsy (19.59%), atrial septal defect (11.76%), sickle cell disease (8.63%), and moyamoya disease (5.41%) in pediatric acute ischemic stroke patients. Unadjusted analysis showed high prevalence of all-cause in-hospital mortality in combined endovascular thrombectomy and intravenous recombinant tissue plasminogen activator utilization group, and higher prevalence of hemorrhagic conversion and morbidity in endovascular thrombectomy utilization group compared to other groups ( p < 0.0001). Multivariate adjusted analysis showed that children with endovascular thrombectomy utilization (aOR: 19.19; 95% CI: 2.50–147.29, p = 0.005), intravenous recombinant tissue plasminogen activator utilization (aOR: 8.85; 95% CI: 1.92–40.76, p = 0.005), and both (endovascular thrombectomy and intravenous recombinant tissue plasminogen activator) utilization (aOR: 7.55; 95% CI: 1.16–49.31, p = 0.035) had higher odds of hemorrhagic conversion compared to no-treatment group. Conclusion We found various risk factors associated with pediatric stroke. The early identification can be useful to formulate preventive strategies and influence the incidence of pediatric stroke. Our study results showed that use of intravenous recombinant tissue plasminogen activator and endovascular thrombectomy increase risk of mortality and hemorrhagic conversion, but we suggest to have more clinical studies to evaluate the idea candidates for utilization of intravenous recombinant tissue plasminogen activator and endovascular thrombectomy based on risk: benefit ratio.

Rapid Endovascular Treatment of Acute Ischemic Stroke: What a General Radiologist Should Know

2017 ◽  
Vol 68 (2) ◽  
pp. 154-160 ◽  
Author(s):  
Elizabeth H.Y. Du ◽  
Jai J.S. Shankar
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Standard Of Care ◽  
Stroke Care ◽  
Large Vessel ◽  
Anterior Circulation ◽  
Endovascular Thrombectomy ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Workflow Efficiency

Stroke is the second leading cause of mortality and the third leading cause of disability-adjusted life-years worldwide. For each minute of an ischemic stroke, an estimated 1.9 million brain cells die. The year 2015 saw the unprecedented publication of 5 multicentre, randomized, controlled trials. These studies showed that patients with acute ischemic stroke caused by large-vessel thrombus occlusion of the proximal anterior circulation had significantly reduced disability at 90 days when treated with endovascular thrombectomy and usual stroke care compared to usual stroke care alone. As a result, endovascular thrombectomy is now the new North American and European standard of care for suitable patients with acute ischemic stroke caused by large-vessel proximal anterior circulation occlusion. We review key take-home messages in this paradigm shift for radiologists, including the importance of time and workflow efficiency, what currently constitutes appropriate preimaging patient selection and imaging criteria, the use of newer generation thrombectomy devices, safety outcomes, as well as further areas still in need of elucidation.

scholarly journals Pediatric Stroke Imaging

2018 ◽  
Vol 86 ◽  
pp. 5-18 ◽  
Author(s):  
Alexander Khalaf ◽  
Michael Iv ◽  
Heather Fullerton ◽  
Max Wintermark
Keyword(s):  
Pediatric Stroke ◽  
Stroke Imaging
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