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A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience
Author(s) -
Alonso de Leciñana M.,
Fuentes B.,
XiménezCarrillo Á.,
Vivancos J.,
Masjuan J.,
GilNuñez A.,
MartínezSánchez P.,
ZapataWainberg G.,
CruzCulebras A.,
GarcíaPastor A.,
DíazOtero F.,
Fandiño E.,
Frutos R.,
Caniego J.L.,
Méndez J.C.,
FernándezPrieto A.,
BárcenaRuiz E.,
DíezTejedor E.
Publication year - 2016
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.12749
Subject(s) - medicine , thrombolysis , contraindication , modified rankin scale , stroke (engine) , ischaemic stroke , endovascular treatment , acute stroke , revascularization , penumbra , ischemic stroke , emergency medicine , pediatrics , myocardial infarction , surgery , tissue plasminogen activator , ischemia , mechanical engineering , alternative medicine , pathology , engineering , aneurysm
Background and purpose The complexity and expense of endovascular treatment ( EVT ) for acute ischaemic stroke ( AIS ) can present difficulties in bringing this approach closer to the patients. A collaborative node was implemented involving three stroke centres ( SC s) within the Madrid Stroke Network to provide round‐the‐clock access to EVT for AIS . Methods A weekly schedule was established to ensure that at least one SC was ‘on‐call’ to provide EVT for all those with moderate to severe AIS due to large vessel occlusion, >4.5 h from symptom onset, or within this time‐window but with contraindication to, or failure of, systemic thrombolysis. The time‐window for treatment was 8 h for anterior circulation stroke and <24 h in posterior stroke. Outcomes measured were re‐canalization rates, modified Rankin Scale ( mRS ) score at 3 months, mortality and symptomatic intra‐cranial haemorrhage (SICH). Results Over a 2‐year period (2012–2013), 303 candidate patients with AIS were considered for EVT as per protocol, and 196 (65%) received treatment. Reasons for non‐treatment were significant improvement (14%), spontaneous re‐canalization (26%), clinical worsening (9%) or radiological criteria of established infarction (31%). Re‐canalization rate amongst treated patients was 80%. Median delay from symptom onset to re‐canalization was 323 min (p25; p75 percentiles 255; 430). Mortality was 11%; independence ( mRS 0–2) was 58%; SICH was 3%. Conclusions 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.