Primary and Comprehensive Stroke Centers: History, Value and Certification Criteria

Gorelick, Philip B.

doi:10.5853/jos.2013.15.2.78

Cited by 89 publications

(73 citation statements)

References 78 publications

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“…To increase the likelihood of rapid recanalization by IAT in patients with acute ischemic stroke, comprehensive stroke centers with experienced personnel should be established, where round‐the‐clock IAT is available. Even though the US and several European countries have established such centers (Gorelick, 2013; Leys, Ringelstein, Kaste, & Hacke, 2007), other countries face economic and expertise‐related limitations. Governments, including that of South Korea, should rapidly establish comprehensive stroke centers (Kim et al., 2014).…”

Section: Discussionmentioning

confidence: 99%

Cost benefits of rapid recanalization using intraarterial thrombectomy

et al. 2017

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ObjectivesThrombolytic therapy is associated with favorable clinical outcomes after successful and rapid recanalization in patients with acute ischemic stroke. This study aimed to evaluate the cost benefits and clinical outcomes at 1 year after intraarterial thrombectomy (IAT) by the rapidity of the successful recanalization.Materials & MethodsClinical outcomes of and medical costs incurred by 230 patients with acute ischemic stroke who underwent IAT were compared by the rapidity from symptom onset to successful recanalization (2b/3 thrombolysis in cerebral infarction grade): ≤6‐hr (n = 143), >6‐hr (n = 31), and no‐recanalization (n = 56). Clinical outcomes including functional independence (0–2 modified Rankin Score), mortality, and home‐discharge checked at 1 year post‐IAT were compared among the three groups. Cost utility was calculated using quality‐adjusted life years (QALY) estimated using the EuroQol‐5 dimensions‐3 levels questionnaire and the fees paid for institutional rehabilitation during the year post‐IAT, and, was compared among the groups.ResultsPatients in the ≤6‐hr group showed higher functional independence (≤6‐hr, 70%; >6‐hr, 40%; no‐recanalization, 6%, p < .001) and home‐discharge rate (73%, 52%, 21%, and respectively, p < .001), and lower mortality (10%, 16%, and 43%, respectively, p < .001) at 1 year after IAT than other two groups. The cost utility of the ≤6‐hr group was $35,557/QALY higher than that of the >6‐hr group, and $27.829/QALY higher than no‐recanalization group.ConclusionsRapid and successful recanalization of the occluded intracranial vessels within 6 hr after the onset of symptoms resulted in markedly higher cost utility and functional independence at 1 year post‐IAT.

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Section: Discussionmentioning

confidence: 99%

Cost benefits of rapid recanalization using intraarterial thrombectomy

et al. 2017

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“…In other countries, despite differences in the directions and ideas for organizing nationwide infrastructure for stroke care system, PSCs are key units of organizations to provide nationwide quality care for stroke. [5][6][7] PSCs, which aim to provide acute management of patients with stroke, could start intravenous thrombolysis after inclusion criteria evaluation. If a patient requires intra-arterial thrombolysis as bridging or primary therapy after initial therapy in a PSC, the patient will be transferred to a Regional CSC.…”

Section: Discussionmentioning

confidence: 99%

“…5 The United States and Europe have been trying to improve nationwide care quality of stroke through the systematic organization of stroke centers. 6,7 In 2008, the Ministry of Health and Welfare (MHW) of South Korea initiated the Regional Comprehensive Stroke Center (CSC) program to decrease the incidence and mortality of stroke. 4 Thus, CSCs were established in 9 local provincial regions nationwide, excluding the Seoul metropolitan area.…”

mentioning

confidence: 99%

Establishment of Government-Initiated Comprehensive Stroke Centers for Acute Ischemic Stroke Management in South Korea

Kim¹,

Hwang²,

Kim³

et al. 2014

Stroke

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Background and Purpose-In 2008, the Ministry of Health and Welfare of South Korea initiated the Regional ComprehensiveStroke Center (CSC) program to decrease the incidence and mortality of stroke nationwide. We evaluated the performance of acute ischemic stroke management after the Regional CSC program was introduced. Methods-The Ministry of Health and Welfare established 9 Regional CSCs in different provinces from 2008 to 2010. All Regional CSCs have been able to execute the critical processes independently for stroke management since 2011. The Ministry of Health and Welfare was responsible for program development and financial support, the Regional CSC for program execution, and the Korea Centers for Disease Control and Prevention for auditing the execution. We analyzed prospectively collected data on the required indices from 2011 and repeated the analysis the following year for comparison. Results-After the Regional CSCs were established, the first brain image was taken within 1 hour from arrival at the emergency room for all patients with stroke; the length of hospital stay decreased from 14 to 12 days; for the rapid execution of thrombolysis, the first brain image was taken within 12 minutes; intravenous and intra-arterial thrombolysis were started within 40 and 110 minutes, respectively, after emergency room arrival; and the hospital stay of thrombolytic patients decreased from 19 to 15 days. Conclusions-The

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“…[30][31][32] The firsttier stroke centre should be capable of providing 24-hour urgent CT and CT angiogram with roundthe-clock IV-tPA service. All patients with suspicious stroke symptoms, such as acute hemiplegia or dysphasia, should be directly transferred to one of these first-tier stroke centres, bypassing other non-stroke centres in emergency hospitals to avoid unnecessary delay in diagnosis.…”

Section: Incorporating Emergency Thrombectomy In Acute Stroke Care Inmentioning

confidence: 99%

Emergency thrombectomy for acute ischaemic stroke: current evidence, international guidelines, and local clinical practice

et al. 2018

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Acute ischaemic stroke due to large vessel occlusion leads to grave neurological morbidity and mortality. Conventional intravenous thrombolysis is ineffective in achieving timely reperfusion in this group of patients. The publication of five positive randomised controlled trials of emergency thrombectomy for acute ischaemic stroke in 2015 provided strong evidence to support endovascular reperfusion therapy and represented a paradigm shift in acute stroke management. In this article, we review the current evidence and international guidelines, and report on the findings of a survey study of the clinical practice and opinions of local neurologists, neurosurgeons, and interventional radiologists in emergency thrombectomy. We also discuss the controversies around thrombectomy treatment, local experience, and suggestions to incorporate

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Primary and Comprehensive Stroke Centers: History, Value and Certification Criteria

Cited by 89 publications

References 78 publications

Cost benefits of rapid recanalization using intraarterial thrombectomy

Cost benefits of rapid recanalization using intraarterial thrombectomy

Establishment of Government-Initiated Comprehensive Stroke Centers for Acute Ischemic Stroke Management in South Korea

Emergency thrombectomy for acute ischaemic stroke: current evidence, international guidelines, and local clinical practice

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