Mechanical Thrombectomy Saves Lives
Stroke is ranked as a leading cause of death for Americans according to the most recent statistics from the Centers for Disease Control and Prevention (CDC). And not only does the burden of stroke cause high mortality rates, but morbidity caused by stroke produces serious long-term disability (Tsao, 2023).
Consequently, stroke is of immense public health importance and poses serious economic consequences with direct annual costs, in the United States, reported to be over $35 billion in 2019 and continue to rise (Boggs, 2022). Acute ischemic stroke (AIS) accounts for approximately 87% of all strokes, according to the CDC statistics, and approximately 30% of those patients, research shows, have a large vessel occlusion (LVO) in which mechanical thrombectomy (MT) may be indicated. In addition, research has indicated that mechanical thrombectomy is associated with a reduction in the risk of death (Oliveira et all, 2022).
As treatment for stroke continues to evolve dramatically, mechanical thrombectomy is increasingly more important in the treatment of AIS with research continuing to show mechanical thrombectomy’s success to reduce disability, improving quality of life, and saving lives.
In 2017, The Joint Commission in collaboration with the American Heart Association/American Stroke Association, launched advanced stroke certification for Thrombectomy‐Capable Stroke Centers (TSCs), with a goal to build stroke care systems that optimize population health outcomes, eliminating healthcare disparities, and providing a dispersed network of hospitals capable of providing mechanical thrombectomy (Goyal, et al, 2015).
More Hospitals Need to Embrace Thrombectomy-Capable Stroke Centers
This introduction of thrombectomy-capable certification increased the number of thrombectomy-capable stroke centers in the US from 2018 to 2021, according to the Society of Vascular and Interventional Neurology, but roughly still only about 35% of stroke centers are thrombectomy capable. And according to an analysis presented at the 2021 Congress of Neurological Surgeons, approximately only 65% of US residents have one-hour access to thrombectomy-capable stroke centers (Waqas, et al, 2022), despite that research has shown that mechanical thrombectomy is the most effective treatment for selected patients with an AIS due to large vessel occlusions (LVOs). And in 2015, mechanical thrombectomy, with or without intravenous thrombolysis, became an additional standard of care for AIS large vessel occlusion (AHA, 2021).
Although mechanical thrombectomy is the standard of care for patients with an LVO, issues surrounding access indicate that the systems of stroke care require further development to optimize thrombectomy access. Simply put, more hospitals need to invest in providing mechanical thrombectomy for stroke.
Advancing to a Thrombectomy Capable Stroke Center
As more hospitals employ the use of new, innovative treatment strategies and consider the investment in mechanical thrombectomy capabilities to ensure their patients have access to this life-saving procedure, the number of deaths and disability due to stroke can be reduced.
But not every hospital is ready to advance to thrombectomy capable. In order to assess a hospital’s readiness to become thrombectomy capable, Corazon starts with an analysis of the current stroke treatment protocols and resources available in the hospital and includes an evaluation of the existing stroke team, therapy options, and technology. Next, areas for improvement are identified, strategies are outlined to address these opportunities, and a timeline and budget for becoming thrombectomy capable are developed. Finally, the hospital should develop an assessment and review process to ensure compliance with the new protocols and ensure continuous improvement.
A reasonable timeline and budget for becoming thrombectomy capable can vary greatly depending on the size and resources of the hospital. But in Corazon’s experience, a reasonable timeline may include a 6–9-month period for implementation and training followed by a 3-month period for optimization. A realistic budget should include costs for hiring any needed additional staff, training, equipment, and resources. Additionally, protocols and processes to ensure safe and effective delivery of care for thrombectomy procedures will need to be developed.
At 2022’s American Stroke Association International Stroke Conference, a new national study’s results were shared that found patients with ischemic stroke who received care at either a Comprehensive Stroke Center or Thrombectomy-capable Stroke Center were more likely to be discharged home or to rehabilitation centers.
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If you need help in determining if your stroke center is ready to advance, able to meet volume requirements, or should pursue certification as a Comprehensive Stroke Center or Thrombectomy-capable Stroke Center, Corazon has expertise in assessing and implementing programs throughout the US.
Author: Carol Wesley
American Heart Association, (2023) Stroke; Accessed online at: https://www.ahajournals.org/
Boggs KM, Vogel BT, Zachrison KS, Espinola JA, Faridi MK, Cash RE, Sullivan AF, Camargo CA Jr. An inventory of stroke centers in the United States. J Am Coll Emerg Physicians Open. 2022 Feb 28;3(2):e12673. doi: 10.1002/emp2.12673. PMID: 35252972; PMCID: PMC8886184
Centers for Disease Control and Prevention (CDC). Stroke Statistics, March 2023; National Center for Chronic Disease Prevention and Health Promotion, Division for Heart Disease and Stroke Prevention, Available online at: https://www.cdc.gov/stroke/statistics_maps.htm
Donkor, E. S. (2018). Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Research and Treatment, 2018, 10. https://doi.org/10.1155/2018/3238165 Accessed online at: https://www.proquest.com/docview/2153557712
Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015; 372:1019–1030. https://doi.org/10.1056/NEJMoa141490
Oliveira AJF, Viana SMN, Santos AS. Mechanical thrombectomy for acute ischemic stroke: systematic review and meta-analysis. Einstein (Sao Paulo). 2022 Aug 8;20:eRW6642. doi: 10.31744/einstein_journal/2022RW6642. PMID: 35946742; PMCID: PMC9345509.