The impact of evidence: Evolving therapy for acute ischemic stroke in a large healthcare system

Justin R Mascitelli, Natalie Wilson, Hazem Shoirah, Reade A. De Leacy, Sunil V. Furtado, Srinivasan Paramasivam, Eric K. Oermann, William J. Mack, Stanley Tuhrim, Neha S. Dangayach, Stephan A. Meyer, Joshua B. Bederson, J. Mocco, Johanna T. Fifi

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Background With a recent surge of clinical trials, the treatment of ischemic stroke has undergone dramatic changes. Objective To evaluate the impact of evidence and a revamped stroke protocol on a large healthcare system. Methods A retrospective review of 69 patients with ischemic stroke treated with intra-arterial therapy was carried out. Cohort 1 included patients treated before implementation of a new stroke protocol, and cohort 2 after implementation. Angiographic outcome was graded using the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcomes were assessed using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Results Primary outcomes comparing cohorts demonstrated decreased arrival-to-puncture time (cohort 2: 104 vs cohort 1: 181min, p<0.001), similar TICI 2b/3 rates (86.5% vs 81.3%, p=0.5530), and similar percentage of patients with discharge mRS 0-2 (18.9% vs 21.9%, p=0.7740). Notable secondary outcomes for cohort 2 included decreased puncture-to-first pass time (34 vs 53 min, p <0.001), increased TICI 3 rates (37.8% vs 18.8%, p=0.0290), a trend toward greater improvements in NIHSS on postoperative day 1 (6.8 vs 2.6, p=0.0980) and discharge (9.5 vs 6.7, p=0.1130), and a trend toward increased percentage of patients discharged with mRS 0-3 (48.6% vs 34.4%, p=0.3280 NS). There were similar rates of symptomatic intracerebral hemorrhage (10.8% vs 9.4%, p=0.9570) and death (10.8% vs 15.6%, p=0.5530). Conclusions An interdisciplinary and rapid response to the emergence of strong clinical evidence can result in dramatic changes in a large healthcare system.

Original languageEnglish (US)
Pages (from-to)1129-1135
Number of pages7
JournalJournal of NeuroInterventional Surgery
Volume8
Issue number11
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

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Keywords

  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Mascitelli, J. R., Wilson, N., Shoirah, H., De Leacy, R. A., Furtado, S. V., Paramasivam, S., Oermann, E. K., Mack, W. J., Tuhrim, S., Dangayach, N. S., Meyer, S. A., Bederson, J. B., Mocco, J., & Fifi, J. T. (2016). The impact of evidence: Evolving therapy for acute ischemic stroke in a large healthcare system. Journal of NeuroInterventional Surgery, 8(11), 1129-1135. https://doi.org/10.1136/neurintsurg-2015-012117