Thrombectomy-Capable Stroke Centre—A Key to Acute Stroke Care System Improvement? Retrospective Analysis of Safety and Efficacy of Endovascular Treatment in Cardiac Cathlab

Abstract

The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity—thrombectomy-capable stroke centre (TCSC)—was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis—the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes.

World Federation for Interventional Stroke Treatment (WIST) multispecialty training guidelines for endovascular stroke intervention

“…Structured training without barriers between specialties is essential. It has long been demonstrated that quality interventional stroke care can be delivered by different specialists such as neuroradiologists, cardiologists, radiologist, neurosurgeons, vascular specialties, or neurologists experienced in endovascular procedures [28][29][30][31][32][33]. This highlights the importance of good training guidelines.…”

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

“…Seamless collaborations between radiologists and neurologists stand as a beacon of hope for patients. In our study, we meticulously screened patients using CT/CTA or MRI before initiating any intervention [170]. The focus group comprised acute ischemic stroke patients, primarily attributed to large vessel occlusions (LVO) and, more specifically, those at the M2 level.…”

“…The exclusions were patients displaying pronounced massive strokes on scans, especially encompassing more than a third of the MCA's territory. Ethical considerations were paramount, with informed consent being a requisite for all study participants [170,171].…”

Making endovascular stroke treatment possible: training to save brains (and lives)

“…Modern simulators, together with experienced instructors/interventionalists offer cognitive and technical training that is at least equivalent to hands-on-the-patient training. WIST guidelines map out a rational and effective approach to meeting the demand for EST, which fits within any modern healthcare system [ 8 , 24 , 25 , 29 – 34 ].…”