Restricted accessResearch articleFirst published online 2011-9
A Systems Approach towards Intra-Arterial Management of Acute Ischemic Stroke: Need for Novel Outcome Measures and a Focus on Sequence Rather Than Steps
In this editorial, we seek to focus attention of neurointerventionists and stroke physicians towards a systems approach to the intra-arterial management of acute ischemic stroke. We highlight the need to pay attention to the overall sequence and workflow of a neurointerventional procedure rather than individual steps. We also stress the importance of novel outcome measures in analyzing procedural efficacy when managing patients with acute ischemic stroke.
TomsickTBroderickJCarrozellaJ. Revascularization results in the Interventional Management of Stroke II trial. Am J Neuroradiol. 2008; 29: 582–587.
2.
The penumbra pivotal stroke trial: Safety and effectiveness of a new generation of mechanical devices for clot removal in intracranial large vessel occlusive disease. Stroke. 2009; 40: 2761–2768.
3.
RothCPapanagiotouPBehnkeS. Stent-assisted mechanical recanalization for treatment of acute intracerebral artery occlusions. Stroke. 2010; 41: 2559–2567.
4.
MenonBKKocharPAh-SengA. Initial experience with a self-expanding retrievable stent for recanalization of large vessel occlusions in acute ischemic stroke. Neuroradiology. 2011; DOI: 10.1007/s00234-010-0835-x.
5.
MenonBKHillMDEesaM. Initial experience with the Penumbra Stroke System for recanalization of large vessel occlusions in acute ischemic stroke. Neuroradiology. 2011; 53: 261–266.
6.
KhatriPAbruzzoTYeattsSD. Good clinical outcome after ischemic stroke with successful revascularization is time-dependent. Neurology. 2009; 73: 1066–1072.
7.
CouttsSBGoyalM. When recanalization does not improve clinical outcomes. Stroke. 2009; 40: 2661.
8.
GoyalMMenonBKCouttsSB. Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombectomy of acute ischemic strokes. Stroke. 2011; 42: 93–97.
9.
EesaMMenonBKHillMD. Achieving faster recanalization times by IA thrombolysis in acute ischemic stroke: Where should we direct our efforts?Interventional Neuroradiology. 2011; 17: 228–234.
10.
LacyCRSuhDCBuenoM. Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke. 2001; 32: 63–69.
11.
CloftHJRabinsteinALanzinoG. Intra-arterial stroke therapy: An assessment of demand and available work force. Am J Neuroradiol. 2009; 30: 453–458.
12.
MaestroniAMandelliCManganaroD. Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy. Emerg Med J.2008; 25: 340–345.
13.
NicholsCCarrozzellaJYeattsS. Is peri-procedural sedation during acute stroke therapy associated with poorer functional outcomes?J Neurointervent Surg.2010; 2: 67–70.
14.
SalottoloKMFanaleCVLeonardKA. Multimodal imaging does not delay intravenous thrombolytic therapy in acute stroke. Am J Neuroradiol. 2011; doi: 10.3174/ajnr.A2394.
15.
RomanoJGMullerNMerinoJG. In-hospital delays to stroke thrombolysis: Paradoxical effect of early arrival. Neurol Res.2007; 29: 664–666.
16.
MosleyINicolMDonnanG. The impact of ambulance practice on acute stroke care. Stroke. 2007; 38: 2765–2770.