Trends in Endovascular Mechanical Thrombectomy in Treatment of Acute Ischemic Stroke in the United States

MacKenzie, Isobel E.R.; Moeini-Naghani, Iman; Sigounas, Dimitri

doi:10.1016/j.wneu.2020.03.105

Cited by 37 publications

(16 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the United States and Germany, approximately 3.1-4.7% of the AIS population received ECR treatment in 2016. 11,12 Based on the current trend of expansion, it is estimated that between 10% and 17% of AIS patients will be eligible for ECR worldwide. 11,13,14 Of note, the percentage of AIS patients who were potentially eligible for ECR was as high as 13% based on South Australia local data in 2016.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Based on the current trend of expansion, it is estimated that between 10% and 17% of AIS patients will be eligible for ECR worldwide. 11,13,14 Of note, the percentage of AIS patients who were potentially eligible for ECR was as high as 13% based on South Australia local data in 2016. 13 With the time window for ECR expanded to between 6 and 24 h after symptoms onset, the future demand for ECR is likely to be even higher than the previous estimation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Application of a computational model in simulating an endovascular clot retrieval service system within regional Australia

et al. 2021

View full text Add to dashboard Cite

Introduction:The global demand for endovascular clot retrieval (ECR) has grown rapidly in recent years creating challenges to healthcare system planning and resource allocation. This study aims to apply our established computational model to predict and optimise the performance and resource allocation of ECR services within regional Australia, and applying data from the state of South Australia as a modelling exercise. Method: Local geographic information obtained using the Google Maps application program interface and real-world data was input into the discrete event simulation model we previously developed. The results were obtained after the simulation was run over 5 years. We modelled and compared a single-centre and two-centre ECR service delivery system. Results: Based on the input data, this model was able to simulate the ECR delivery system in the state of South Australia from the moment when emergency services were notified of a potential stroke patient to potential delivery of ECR treatment. In the model, ECR delivery improved using a two-centre system compared to a one-centre system, as the percentage of stroke patients requiring ECR was increased. When 15% of patients required ECR, the proportion of 'failure to receive ECR' cases for a single-centre system was 17.35%, compared to 3.71% for a two-centre system. Conclusions: Geolocation and resource utilisation within the ECR delivery system are crucial in optimising service delivery and patient outcome. Under the model assumptions, as the number of stroke cases requiring ECR increased, a two-centre ECR system resulted in increased timely ECR delivery, compared to a single-centre system. This study demonstrated the flexibility and the potential application of our DES model in simulating the stroke service within any location worldwide.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Application of a computational model in simulating an endovascular clot retrieval service system within regional Australia

et al. 2021

View full text Add to dashboard Cite

show abstract

“…10 Yet approximately only 3.1% of acute ischemic stroke patients received MT in 2016. 11 This number increased to 8.4 % among patients treated at 176 endovascular centers in 2018. 12 Despite the increasing use of MT, there continues to be a large proportion of patients who do not receive MT or receive it in a delayed fashion because of a lack of access to treatment, defined as the "timely use of personal health services to achieve the best health outcomes."…”

Section: Measuring Accessmentioning

confidence: 99%

Mechanical Thrombectomy Access for All? Challenges in Increasing Endovascular Treatment for Acute Ischemic Stroke in the United States

et al. 2022

View full text Add to dashboard Cite

Mechanical thrombectomy (MT) is the most effective treatment for selected patients with an acute ischemic stroke due to emergent large vessel occlusions (LVOs). There is an urgent need to identify and address challenges in access to MT to maximize the numbers of patients who can benefit from this treatment. Barriers in access to MT include delays in evaluation and accurate diagnosis of LVO leading to inappropriate triage, logistical delays related to availability of facilities and trained interventionalists, and financial hurdles that affect treatment reimbursement. Collection of regional data related to these barriers is critical to better understand current access gaps and a measurable access score to thrombectomy could be useful to plan local public health intervention.

show abstract

“…Strokes due to large vessel occlusions are treated in the hospitals using mechanical thrombectomy within 24 h from symptom onset when imaging shows a salvageable penumbra or when there is a mismatch between clinical deficit and infarct size (3)(4)(5)(6). Although there has been a steady increase in intravenous alteplase use and endovascular thrombectomy (7), missed opportunities still exist (8,9). Therefore, a global priority is to increase access to these time-sensitive treatments through streamlined care in the prehospital and emergency department settings.…”

Section: Introductionmentioning

confidence: 99%

Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study

Mulkerin

Spokoyny

Francisco³

et al. 2021

Front. Neurol.

View full text Add to dashboard Cite

Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes.Method: In this prospective cohort study conducted over a 20-month period (11/2016–6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS.Results: Of the 31 patients, the mean difference (prehospital mNIHSS—hospital mNIHSS) was 2.4, 95% limits of agreement (−5.2 to 10.0); 10 patients (32%) met our a priori imaging definition of large vessel occlusion and the sensitivity of mNIHSS ≥ 8 was 6/10 or 0.60 (95% CI: 0.26–0.88) and the specificity was 13/21 or 0.62 (95% CI: 0.38–0.82), respectively.Conclusions: We were able to train prehospital providers to use the prehospital mNIHSS. Prehospital and hospital mNIHSS had a reasonable level of agreement and and the scale was able to predict large vessel occlusions with moderate sensitivity.

show abstract

Trends in Endovascular Mechanical Thrombectomy in Treatment of Acute Ischemic Stroke in the United States

Cited by 37 publications

References 19 publications

Application of a computational model in simulating an endovascular clot retrieval service system within regional Australia

Application of a computational model in simulating an endovascular clot retrieval service system within regional Australia

Mechanical Thrombectomy Access for All? Challenges in Increasing Endovascular Treatment for Acute Ischemic Stroke in the United States

Prehospital Identification of Large Vessel Occlusions Using Modified National Institutes of Health Stroke Scale: A Pilot Study

Contact Info

Product

Resources

About