Updating estimates of the number of UK stroke patients eligible for endovascular thrombectomy: incorporating recent evidence to facilitate service planning

Introduction Endovascular thrombectomy (EVT) is a highly effective treatment for acute ischaemic stroke due to large arterial occlusion (LAO). To support decisions about service provision, we previously estimated the annual UK population eligible for EVT as ∼10% of stroke admissions. Since then, several trials have produced evidence that could alter these figures. We update our estimates considering information from studies and trials reporting 2018–2021 on incidence, presentation time and stroke severity and consider the possible impact of predicted demographic changes in the next 10–20 years. Patients and Methods We produce an updated decision tree describing the EVT eligible population for UK stroke admissions. One-way sensitivity analyses (using upper and lower confidence intervals for estimates at each branch of our decision tree) were used to identify where further research evidence is necessary to increase certainty around estimates for numbers of EVT eligible patients. Results The updated estimate for the number of UK stroke patients eligible for EVT annually was between 10,020 (no advanced imaging in early presenting patients) and 9,580 (advanced imaging in all early presenting patients), which compared with our estimates in 2017 is a minimal reduction. One-way sensitivity analyses established that enhanced evidence about eligibility for milder strokes, ASPECTS scores and pre-stroke disability are offset by evidence regarding a lower incidence of LAO. Importantly, predicted increases in life expectancy by 2040 may increase thrombectomy need by 40%. Discussion Information from additional randomised trials published during 2018–2020 with updated estimates of LAO prevalence had a minimal impact on overall estimates of stroke patients eligible for EVT in the UK. Ongoing research into the benefits of EVT for patients with mild stroke or European Stroke Journal For Peer Review lower ASPECTS scores has the potential to increase the estimates of the eligible population; future need for EVT will increase with the ageing population. Conclusion Our updated analyses show overall numbers eligible little changed, but evidence from ongoing trials and demographic changes have the potential to increase the need for EVT significantly.

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Estimating the number of UK stroke patients eligible for endovascular thrombectomy

European Stroke Journal ◽

10.1177/2396987317733343 ◽

2017 ◽

Vol 2 (4) ◽

pp. 319-326 ◽

Cited By ~ 46

Author(s):

Peter McMeekin ◽

Philip White ◽

Martin A James ◽

Christopher I Price ◽

Darren Flynn ◽

...

Keyword(s):

Arterial Occlusion ◽

Intravenous Thrombolysis ◽

Sensitivity Analyses ◽

Stroke Patients ◽

Advanced Imaging ◽

Stroke Incidence ◽

Endovascular Thrombectomy ◽

Decision Points ◽

Published Evidence ◽

Randomised Control Trials

Introduction Endovascular thrombectomy is a highly effective treatment for acute ischemic stroke due to large arterial occlusion. Routine provision will require major changes in service configuration and workforce. An important first step is to quantify the population of stroke patients that could benefit. We estimated the annual UK population suitable for endovascular thrombectomy using standard or advanced imaging for patient selection. Patients and methods Evidence from randomised control trials and national registries was combined to estimate UK stroke incidence and define a decision-tree describing the endovascular thrombectomy eligible population. Results Between 9620 and 10,920 UK stroke patients (approximately 10% of stroke admissions) would be eligible for endovascular thrombectomy annually. The majority (9140–9620) would present within 4 h of onset and be suitable for intravenous thrombolysis. Advanced imaging would exclude 500 patients presenting within 4 h, but identify an additional 1310 patients as eligible who present later. Discussion Information from randomised control trials and large registry data provided the evidence criterion for 9 of the 12 decision points. The best available evidence was used for two decision points with sensitivity analyses to determine how key branches of the tree affected estimates. Using the mid-point estimate for eligibility (9.6% of admissions) and assuming national endovascular thrombectomy coverage, 4280 patients would have reduced disability. Conclusion A model combining published trials and register data suggests approximately 10% of all stroke admissions in the UK are eligible for endovascular thrombectomy. The use of advanced imaging based on current published evidence did not have a major impact on overall numbers but could alter eligibility status for 16% of cases.

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TAB-TICI Score: Successful Recanalization Score After Endovascular Thrombectomy in Acute Stroke

Frontiers in Neurology ◽

10.3389/fneur.2021.692490 ◽

2021 ◽

Vol 12 ◽

Author(s):

Woo-Keun Seo ◽

Hyo Suk Nam ◽

Jong-Won Chung ◽

Young Dae Kim ◽

Keon-Ha Kim ◽

...

Keyword(s):

Acute Stroke ◽

External Validation ◽

Reperfusion Therapy ◽

Sensitivity Analyses ◽

Stroke Patients ◽

Training Population ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Stroke Registry ◽

Validation Population

Background and Purpose: Successful reperfusion therapy is supposed to be comprehensive and validated beyond the grade of recanalization. This study aimed to develop a novel scoring system for defining the successful recanalization after endovascular thrombectomy.Methods: We analyzed the data of consecutive acute stroke patients who were eligible to undergo reperfusion therapy within 24 h of onset and who underwent mechanical thrombectomy using a nationwide multicenter stroke registry. A new score was produced using the predictors which were directly linked to the procedure to evaluate the performance of the thrombectomy procedure.Results: In total, 446 patients in the training population and 222 patients in the validation population were analyzed. From the potential components of the score, four items were selected: Emergency Room-to-puncture time (T), adjuvant devices used (A), procedural intracranial bleeding (B), and post-thrombectomy reperfusion status [Thrombolysis in Cerebral Infarction (TICI)]. Using these items, the TAB-TICI score was developed, which showed good performance in terms of discriminating early neurological aggravation [AUC 0.73, 95% confidence interval (CI) 0.67–0.78, P < 0.01] and favorable outcomes (AUC 0.69, 95% CI 0.64–0.75, P < 0.01) in the training population. The stability of the TAB-TICI score was confirmed by external validation and sensitivity analyses. The TAB-TICI score and its derived grade of successful recanalization were significantly associated with the volume of thrombectomy cases at each site and in each admission year.Conclusion: The TAB-TICI score is a valid and easy-to-use tool to more comprehensively define successful recanalization after endovascular thrombectomy in acute stroke patients with large vessel occlusion.

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Population Policies in Turkey and Demographic Changes on a Social Map

BORDER CROSSING ◽

10.33182/bc.v6i2.493 ◽

2016 ◽

Vol 6 (2) ◽

pp. 240-266 ◽

Cited By ~ 2

Author(s):

Mustafa Murat Yucesahin ◽

Tuğba Adalı ◽

A Sinan Türkyılmaz

Keyword(s):

Population Policy ◽

Developed Countries ◽

Ageing Population ◽

Demographic Changes ◽

Demographic Transitions ◽

Population Policies ◽

Demographic Indicators ◽

The Social ◽

Working Age ◽

Low Levels

Compared to its past structure, Turkey is now a country with low levels of fertility and mortality. This junction that Turkey now has reached is associated with a number of risks, such as an ageing population, and a decreasing working-age population. The antinatalist policy era of Turkey was followed by a period of maintenance, yet the recent demographic changes formed the basis of a pronatalist population policy from the government’s view. This study discusses the link between demographic change and population policies in Turkey. It further aims to position Turkey spatially in relation to selected countries that are in various stages of their demographic transitions with different population policies, using a multidimensional scaling approach with data on 25 selected countries from the UN. The analysis is based on a 34-year period, 1975-2009, so as to better demonstrate Turkey’s international position on a social map, past and present. Our findings suggest that Turkey’s position on the social map shifted towards developed countries over time in terms of demographic indicators and population policies.

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E-033 Procedural outcome depending arterial diameter in the acute M2 occlusive ischemic stroke patients treated with endovascular thrombectomy

10.1136/neurintsurg-2021-snis.129 ◽

2021 ◽

Author(s):

J Kim ◽

K Lee ◽

J Kang ◽

B Kim ◽

M Han ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Patients ◽

Arterial Diameter ◽

Endovascular Thrombectomy ◽

Procedural Outcome

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Prognostic value of elevated high-sensitivity cardiac troponin T in acute ischemic stroke patients treated with endovascular thrombectomy in late time windows

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106921 ◽

2021 ◽

pp. 106921

Author(s):

Yi Wu ◽

Yue-Zhou Cao ◽

Lin-Bo Zhao ◽

Zhen-Yu Jia ◽

Sheng Liu ◽

...

Keyword(s):

Ischemic Stroke ◽

Cardiac Troponin ◽

Prognostic Value ◽

Troponin T ◽

Time Windows ◽

High Sensitivity ◽

Cardiac Troponin T ◽

Late Time ◽

Stroke Patients ◽

Endovascular Thrombectomy

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Abstract P355: Real-Word Performance of Two Automated Software Platforms for Identification of Salvageable Tissue in Stroke Patients: A Single Center Experience

Stroke ◽

10.1161/str.52.suppl_1.p355 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Angelos Katramados ◽

Horia Marin ◽

Maximilian Kole ◽

Owais Alsrouji ◽

Pala Varun ◽

...

Keyword(s):

Ct Perfusion ◽

Stroke Patients ◽

Vessel Occlusion ◽

Significant Discrepancy ◽

Endovascular Thrombectomy ◽

Stroke Treatment ◽

Software Platforms ◽

Automated Software ◽

Selection Of Patients ◽

Selection Of

Background and purpose: Modern stroke treatment has been revolutionized by image-guided selection of patients for endovascular thrombectomy. Current automated platforms allow for real-time identification of large vessel occlusion and salvageable brain tissue. We sought to evaluate the performance of these platforms with regard to identification of infarcted and salvageable tissue. Methods: We studied all patients that presented to Henry Ford Health System hospitals over a period of 6 weeks, received CT perfusion imaging of the brain upon initial presentation. The images were processed with two automated software platforms. We prospectively measured volumes of tissue with cerebral blood flow (CBF) < 30% of contralateral hemisphere, Tmax >6 secs, and hypoperfusion indices (defined as the ratio of volumes Tmax>10 secs and Tmax>6 secs). We compared the outputs of the two platforms and analyzed the performance of each platform. Results: 66 scans were included in our study. Both platforms were able to image all stroke patients within their FDA-approved indications. With regard to all scans, both platforms were noted to demonstrate comparable CBF<30% volumes (6.32 ml. vs 4.97 ml, p=0.276), and hypoperfusion indices (0.278 vs 0.338, p=0.344). However, there was statistically significant discrepancy in the volumes of tissue with Tmax>6 secs (23.96 vs 14.18 ml, p=0.023). Analysis of a subset of 12 scans, with evidence of LVO or severe symptomatic stenosis on corresponding CTA, showed again comparable CBF<30% volumes (12.84 ml vs 13.67 ml, p=0.725), and hypoperfusion indices (0.344 vs 0.314, p=0.699). However, the Tmax>6 secs volume discrepancy was greater and still statistically significant (75.54 ml vs 39.58 ml, p=0.048) Conclusions: Automated software platforms are an invaluable aid in the identification of salvageable tissue, and selection of patients for endovascular thrombectomy in the 6-24 hour window. However, the substantial difference in the identified volumes of hypoperfused tissue-at-risk may result in largely different clinical decisions and patient outcomes. Further validation efforts (and harmonization of algorithms) are required. Stroke teams should be aware of the limitations of automated analysis and need for expert review.

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Stroke Patients Classification Using Resampling Techniques and Decision Tree Learning

International Journal of Engineering Trends and Technology ◽

10.14445/22315381/ijett-v69i6p217 ◽

2021 ◽

Vol 69 (6) ◽

pp. 115-120

Author(s):

Sumitra Nuanmeesri ◽

Wongkot Sriurai ◽

Nattanon Lamsamut

Keyword(s):

Decision Tree ◽

Stroke Patients ◽

Decision Tree Learning

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Reducing the severity of stroke

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2018-136157 ◽

2019 ◽

Vol 95 (1123) ◽

pp. 271-278 ◽

Cited By ~ 2

Author(s):

Georgina Meredith ◽

Anthony Rudd

Keyword(s):

Ischaemic Stroke ◽

Intracerebral Haemorrhage ◽

Acute Treatment ◽

Causes Of Death ◽

Stroke Care ◽

Stroke Patients ◽

Advanced Imaging ◽

Effective Prevention

Stroke remains one of the most important causes of death and disability worldwide. Effective prevention could reduce the burden of stroke dramatically. The management of stroke has undergone a revolution over the last few decades, particularly with the development of techniques for revascularisation of patients with ischaemic stroke. Advanced imaging able to identify potentially salvageable brain is further increasing the potential for effective acute treatment. However, the majority of stroke patients won’t benefit from these treatments and will need effective specialist stroke care and ongoing rehabilitation to overcome impairments and adapt to living with a disability. There are still many unanswered questions about the most effective way of delivering rehabilitation. Likewise, research into how to manage primary intracerebral haemorrhage has yet to transform care.

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Aged care nurse practitioners in Australia: evidence for the development of their role

Australian Health Review ◽

10.1071/ah13052 ◽

2013 ◽

Vol 37 (5) ◽

pp. 594 ◽

Cited By ~ 20

Author(s):

Shannon Clark ◽

Rhian Parker ◽

Brenton Prosser ◽

Rachel Davey

Keyword(s):

Nurse Practitioners ◽

Nurse Practitioner ◽

The United States ◽

Aged Care ◽

Service Planning ◽

Current Evidence ◽

Ageing Population ◽

Healthcare Outcomes ◽

The Impact

Aim To consider evidence surrounding the emerging role of nurse practitioners in Australia with a particular focus on the provision of healthcare to older people. Methods Methods used included keyword, electronic database and bibliographic searches of international literature, as well as review of prominent policy reports in relation to aged care and advanced nursing roles. Results This paper reports on evidence from systematic reviews and international studies that show that nurse practitioners improve healthcare outcomes, particularly for hard to service populations. It also maps out the limited Australian evidence on the impact of nurse practitioners’ care in aged care settings. Conclusions If Australia is to meet the health needs of its ageing population, more evidence on the effectiveness, economic viability and sustainability of models of care, including those utilising nurse practitioners, is required. What is known about the topic? Australia, like many industrialised countries, faces unprecedented challenges in the provision of health services to an ageing population. Attempts to respond to these challenges have resulted in changing models of healthcare and shifting professional boundaries, including the development of advance practice roles for nurses. One such role is that of the nurse practitioner. There is international evidence that nurse practitioners provide high-quality healthcare. Despite being established in the United States for nearly 50 years, nurse practitioners are a relatively recent addition to the Australian health workforce. What does this paper add? This paper positions a current Australian evaluation of nurse practitioners in aged care against the background of the development of the role of nurse practitioners internationally, evidence for the effectiveness of the role, and evidence for nurse practitioners in aged care. Recent legislative changes in Australia now mean that private nurse practitioner roles can be fully implemented and hence evaluated. In the face of the increasing demands of an ageing population, the paper highlights limitations in current Australian evidence for nurse practitioners in aged care and identifies the importance of a national evaluation to begin to address these limitations. What are the implications for practitioners? The success of future healthcare planning and policy depends on implementing effective initiatives to address the needs of older Australians. Mapping the terrain of contemporary evidence for nurse practitioners highlights the need for more research into nurse practitioner roles and their effectiveness across Australia. Understanding the boundaries and limitations to current evidence is relevant for all involved with health service planning and delivery.

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