Like so many others, I’ve been influenced by the experiences in my life. One such experience has created a serious passion for advancing the treatment of stroke, helping to lead me to my work here at Corazon.
Since her stroke several years ago, I’ve watched my mother-in-law deal with severe disabilities. Once a very vibrant, alert, and oriented woman with an active social and family life, she’s now confined to a wheelchair, unable to use the right side of her body, and unable to communicate. I’ve watched her frustration as she tries answer even a simple yes or no to a question. Still completely oriented, she was unable to ever regain her speech, and is not able to use her dominant hand to write. When thinking back to that very challenging few years following her stroke until her death, I think about how different things might have been if her stroke had occurred today, in 2020, when we now have mechanical thrombectomy as a viable treatment option. With this more advanced level of neuro interventional care, perhaps her recovery would have been more complete, and her final years not so difficult.
But even now, there are many areas of the country where thrombectomy is unfortunately NOT an option. Researchers at the University of Texas Health Science Center at Houston found that less than 20% of the US population has access to Endovascular Thrombectomy for Large Vessel Occlusion Acute Ischemic Stroke within 15 minutes. Even expanding to 30 minutes for access, still less than 29% can receive this disability-reducing (or in some cases, life-saving!) procedure.
While the Get Ahead of Stroke campaign is making great strides in helping states enact EMS bypass laws that promote taking potential Large Vessel Occlusion (LVO) Acute Ischemic Stroke patients only to facilities that have Endovascular (interventional) capability, this approach remains hampered by the limited number of Endovascular-Capable Stroke Centers. NOW IS THE TIME for hospitals to be evaluating the addition of this service, especially facilities that are already Primary Stroke Certified, as advancing to Thrombectomy-Capable requires a relatively minimal investment of time and resources.
There are approximately 800,000 strokes per year in the US. Nearly 85% of those (680,000) are Ischemic strokes, and conservatively, 20% of those are Large Vessel Occlusions. I say conservatively, as “Acute Ischemic Stroke Interventions: Large Vessel Occlusion and Beyond”, published in Stroke Vascular Neurology in March 2020 estimates closer to 38%. So, around 136,000 to 258,000 possible Large Vessel Occlusion stroke patients could potentially benefit from mechanical thrombectomy. BUT….only approximately 10,000 mechanical thrombectomies performed annually right now in the US!
Stroke is the 5th leading cause of death in the US and the LEADING cause of serious long-term disability. But we have the ability to change this picture. Recent trials such as DAWN and DEFUSE actually ended early, as it was deemed to be unethical to not more widely offer the treatment due to significant differences in outcomes with mechanical thrombectomy. An Overview of Meta-Analyses of Endovascular Bridging Therapies actually showed that on average for every 100 stroke patients treated with thrombectomy, approximately 40 would have less-disabling outcomes, and nearly 23 more will achieve independence post-stroke. So why is this not an absolute standard of care for patients presenting with large vessel occlusion acute ischemic stroke?
To achieve that standard more broadly across the United States, the answer is simple…more thrombectomy-capable centers need to be established, beginning in areas where access is most limited.
Use our online thrombectomy calculator, https://corazoninc.com/thrombectomy-calculator/, to get a rough estimate of your potential volume shift should your organization expand to offer neuro intervention. Using the results as a foundation, Corazon can perform a deeper analysis into your current market to determine volume projections and possible revenue opportunity with the addition of thrombectomy. While there is some significant up-front cost to implement the service, the return on investment is quickly achieved. Thrombectomy, or any advanced care within the neuroscience specialty, can be profitable, but even more importantly, increasing access to this care can save lives and decrease disability in your community.
