Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Stroke endovascular therapy: The more you do, the better you do

Sheth SA et al. ISC 2019, Abstract 002

Key clinical point: The more endovascular thrombectomies a center performs for acute ischemic stroke, the better the patient outcomes.

Major finding: In U.S. national data, for every 10 additional thrombectomies done annually, patients had 30% more “good” discharge outcomes.

Study details: Analyses of 3,890 patients treated in Florida and of 42,505 patients in the National Inpatient Sample.

Disclosures: Dr. Sheth reported no disclosures.

Citation:

Sheth SA et al. ISC 2019, Abstract 002.

Commentary:

The idea that when centers perform more of a procedure, such as endovascular thrombectomy for acute ischemic stroke, they more often do it better is intuitively plausible, which helps makes these findings believable. It’s also a relationship we’ve already seen for other types of endovascular therapies. What this study did not address were other factors beyond case volume also might also make important contributions to outcome, such as the speed of treatment delivery.

It’s been only 4 years since endovascular thrombectomy became standard of care in early 2015 for treating selected patients with an acute ischemic stroke. Since then, the focus of stroke clinicians has largely been on increasing the number of locations where patients could receive this important treatment. There remains a shortage of endovascular availability in many rural U.S. regions. The precedent clearly exists from other types of endovascular interventions for professional societies to set volume minimums that can sometimes be a surrogate marker of a center having and maintaining an optimal level of competence. But I don’t believe that we currently have adequate availability of endovascular stroke therapy to take this step. If we set a volume minimum now, it could deny treatment access to a significant number of patients.

Volume thresholds for endovascular stroke programs will come eventually, but for the time being our focus should be on insuring wide access to endovascular treatment.

Bruce Ovbiagele, MD, a neurologist and chief of staff for the San Francisco Veteran Affairs Health Care System, made these comments in an interview. He reported no disclosures.

This Week's Must Reads

Risk Factors for Suicidality in Huntington Disease, Neurology; ePub 2019 Mar 8; McGarry, et al

Socioeconomic Disparities in US Stroke Survivors, Stroke; ePub 2019 Mar 11; Elfassy, Grasset, et al

Treating Stroke Patients with tPA via Telemedicine, Stroke; ePub 2019 Mar 11; Wysocki, et al

Can a Modified Ketogenic Diet Reduce Seizures?, Epilepsy Behav; ePub 2019 Mar 10; Roehl, et al

No Association Between Self-Reported TBI and AD, Alzheimers Dement; ePub 2019 Mar 6; Sugarman, et al