A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience

Leciñana, M. Alonso de; Fuentes, Blanca; Ximénez-Carrillo, Álvaro; Vivancos, José; Masjuán, Jaime; Gil‐Núñez, A.; Martínez-Sánchez, Patricia; Zapata-Wainberg, Gustavo; Culebras, Antonio; García-Pastor, Andrés; Fernando, Daniel; Fandiño, Eduardo; Frutos, R.; Caniego, José Luis; Méndez, José; Fernández-Prieto, Andrés; Bárcena-Ruiz, E.; Díez‐Tejedor, Exuperio

doi:10.1111/ene.12749

Cited by 30 publications

(23 citation statements)

References 20 publications

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“…We have also implemented the position of the ERT Manager Neurologist who evaluates (via telemedicine or telephone) a patient who is initially treated at a hospital without an SU and is a candidate for ERT. 10 In conclusion, the 41% of transfers for ERT are futile. However, none of the baseline patient characteristics are able to predict this event, and arterial recanalization and findings in the neuroimaging tests performed at the receiving hospital are the main reasons for ERT ineligibility.…”

Section: Discussionmentioning

confidence: 97%

“…This on-call center was responsible for the entire population in the area the 3 CSCs or ≈3 million inhabitants (Northeast Madrid ERT Network). 10 The other half of Madrid's population also has 24-hour/365-day ERT coverage, which has been provided by another CSC until August 2013 when the Southwest Madrid ERT Network was created with the participation of 3 CSCs. Occasionally, patients from other areas of Madrid are accepted if they meet the criteria and do not otherwise have access to ERT, which is often due to an overload at another network.…”

Section: Population and Study Protocolsmentioning

confidence: 99%

“…Demographic, clinical, neuroimaging, and outcome data were recorded prospectively in a common, specific database that included, for the purpose of this analysis, 10 (1) the patient's baseline characteristics; (2) National Institute of Health Stroke Scale on admission; (3) neuroimaging data (ASPECTS, multimodal CT or magnetic resonance imaging, when available); (4) time elapsed from stroke onset to first hospital arrival and to arrival at ERT hospital; (5) frequency of interhospital transfers and their duration; (6) treatment or not with IVT and the reason for exclusion, where applicable; (7) indication for ERT; (8) complications during the interhospital transfer; and (9) outcome at 3 months according to the modified Rankin Scale Score. Patients who were considered for ERT treatment but who were ultimately excluded were also recorded, as well as the reasons for the exclusion.…”

Section: Study Variablesmentioning

confidence: 99%

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Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke

Fuentes

Leciñana

Ximénez-Carrillo

et al. 2015

Stroke

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However, the complexity of this technique justifies the development of collaborative stroke center networks with interhospital transfers of eligible patients. 6 To date, these stroke care networks have been implemented in regional settings, connecting a comprehensive stroke center (CSC) with primary stroke centers and general hospitals. 6 This approach has been designed principally to improve the rates of IVT in IS, but it has also played an important role in patients eligible Background and Purpose-The complexity of endovascular revascularization treatment (ERT) in acute ischemic stroke and the small number of patients eligible for treatment justify the development of stroke center networks with interhospital patient transfers. However, this approach might result in futile transfers (ie, the transfer of patients who ultimately do not undergo ERT). Our aim was to analyze the frequency of these futile transfers and the reasons for discarding ERT and to identify the possible associated factors. Methods-We analyzed an observational prospective ERT registry from a stroke collaboration ERT network consisting of 3 hospitals. There were interhospital transfers from the first attending hospital to the on-call ERT center for the patients for whom this therapy was indicated, either primarily or after intravenous thrombolysis (drip and shift). Results-The ERT protocol was activated for 199 patients, 129 of whom underwent ERT (64.8%). A total of 120 (60.3%) patients required a hospital transfer, 50 of whom (41%) ultimately did not undergo ERT. There were no differences in their baseline characteristics, the times from stroke onset, or in the delays in interhospital transfers between the transferred patients who were treated and those who were not treated. The main reasons for rejecting ERT after the interhospital transfer were clinical improvement/arterial recanalization (48%) and neuroimaging criteria (32%). Conclusions-Forty-one percent of the ERT transfers were futile, but none of the baseline patient characteristics predicted this result. Futility could be reduced if repetition of unnecessary diagnostic tests was avoided.

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Section: Discussionmentioning

confidence: 97%

Section: Population and Study Protocolsmentioning

confidence: 99%

Section: Study Variablesmentioning

confidence: 99%

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Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke

Fuentes

Leciñana

Ximénez-Carrillo

et al. 2015

Stroke

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“…Our data identify a score ≤5 as the best predictive value to forecast futile recanalization. MT has been proven to significantly increase the odds of good outcome in patients with stroke due to proximal intracranial artery occlusions [14][15][16][17][18][19]. However, some patients may not benefit from treatment, the rate of futility being high after MT, especially in cases of larger vessel occlusion.…”

Section: Discussionmentioning

confidence: 99%

Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

et al. 2016

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Esta es la versión de autor del artículo publicado en: This is an author produced version of a paper published in:Neuroradiology 58.5 (2016) In an adjusted model, baseline CTA-SI-ASPECTS was inversely related to the odds of futile recanalization (OR 0.5; 95 % CI 0.3-0.7), whereas NCCT-ASPECTS was not (OR 0.8; 95 % CI 0.5-1.2). A score ≤5 in CTA-SIASPECTS was the best cut-off to predict futile recanalization (sensitivity 35 %; specificity 97 %; positive predictive value 86 %; negative predictive value 77 %).Conclusions CTA-SI-ASPECTS strongly predicts futile recanalization and could be a valuable tool for treatment decisions regarding the indication of revascularization therapies.Keywords Ischemic stroke . CT-angiography . IntroductionEarly recanalization of the occluded vessel is crucial in improving the prognosis of acute ischemic stroke. However, despite achieving successful and prompt . However, the usefulness of this score for treatment decisions has been debated as it has modest inter-rater reliability, and the majority of recent trials of MT excluded patients with poorer baseline ASPECTS score [6]. ASPECTS on CT angiography source images (CTA-SIASPECTS) has been shown to be a more accurate predictor of outcome and final infarct volume in acute ischemic stroke [7,8]. CTA is recommended for the assessment of site of occlusion and vessel anatomy of acute stroke patients who are potential candidates for endovascular treatment [9], CTA data being available in the majority of these patients during their initial evaluation. The aim of this study is to assess whether baseline CTA-SI-ASPECTS might help predict response to treatment and can reliably predict futile recanalization in patients undergoing reperfusion therapies; the intention being to find a reliable tool for treatment decision making.

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“…The Madrid Stroke Network is a collaborative system of care in which MT is provided 24/7 by two nodes composed of three comprehensive stroke centers (CSCs) covering approximately 3.2 million people each, in a weekly rotating shift 19. In this collaborative system, every stroke patient is dispatched to the nearest CSC by emergency medical services.…”

Section: Methodsmentioning

confidence: 99%

Mechanical thrombectomy in patients with medical contraindications for intravenous thrombolysis: a prospective observational study

Leciñana

Martínez-Sánchez

García-Pastor

et al. 2016

J NeuroIntervent Surg

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A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience

Abstract: Implementation of a collaborative network to provide EVT for AIS is feasible and effective. Results are good in terms of re-canalization rates and clinical outcomes.

Cited by 30 publications

References 20 publications

Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke

Futile Interhospital Transfer for Endovascular Treatment in Acute Ischemic Stroke

Alberta Stroke Program Early CT Score applied to CT angiography source images is a strong predictor of futile recanalization in acute ischemic stroke

Mechanical thrombectomy in patients with medical contraindications for intravenous thrombolysis: a prospective observational study

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