Current options to expanding thrombectomy access in your catchment area
Endovascular treatment (EVT) for large vessel occlusion (LVO) acute ischemic stroke has been proven to be highly efficient in reducing disability and may also reduce mortality (at least for basilar artery occlusions). However, several papers have shown that access to EVT is still far from optimal even in highly developed countries with many comprehensive stroke centers. It has been shown that the chance to benefit from thrombectomy is lower for patients living in rural areas or in smaller cities that do not have comprehensive stroke centers. Indeed, the farer away one is from a comprehensive stroke center the higher the likelihood that one will not be eligible for endovascular treatment and the higher the likelihood that a stroke victim will remain with important disability. Given this data several options have been explored to reduce the inequality of access to treatment in several regions. This is a quick review of potential options to expand thrombectomy access in your region.
Mothership vs drip-ship models :
Flying doctor model :
Setting up new thrombectomy capable centers:
Currently tested and available methods to reduce the inequality of access to EVT treatment are heterogenous and depend on each region. There is no perfect model and the only certainty that currently exists is that each region has work-out a model that fits best its geography, economy, population, and medical resources. Obtaining a fast and efficient triage of stroke patients in a region may be the most valuable intervention that a comprehensive stroke center can make to improve outcomes in his catchment area.
1. Pérez de la Ossa, N.; Abilleira, S.; Jovin, T.G.; García-Tornel, Á.; Jimenez, X.; Urra, X.; Cardona, P.; Cocho, D.; Purroy, F.; Serena, J.; et al. Effect of Direct Transportation to Thrombectomy-Capable Center vs Local Stroke Center on Neurological Outcomes in Patients With Suspected Large-Vessel Occlusion Stroke in Nonurban Areas: The RACECAT Randomized Clinical Trial. JAMA 2022, 327, 1782–1794, doi:10.1001/jama.2022.4404.
2. Hubert, G.J.; Hubert, N.D.; Maegerlein, C.; Kraus, F.; Wiestler, H.; Müller-Barna, P.; Gerdsmeier-Petz, W.; Degenhart, C.; Hohenbichler, K.; Dietrich, D.; et al. Association Between Use of a Flying Intervention Team vs Patient Interhospital Transfer and Time to Endovascular Thrombectomy Among Patients With Acute Ischemic Stroke in Nonurban Germany. JAMA 2022, 327, 1795–1805, doi:10.1001/jama.2022.5948.
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