News | Stroke | March 27, 2019

New Stroke Training Model Improves Access to Life-Saving Care

Interventional radiologists may be key to expanding access to timely thrombectomies

New Stroke Training Model Improves Access to Life-Saving Care

March 27, 2019 — Training interventional radiologists to perform endovascular thrombectomies results in positive outcomes for patients experiencing stroke, according to a study presented at the Society of Interventional Radiology (SIR) Annual Scientific Meeting, March 23-28 in Austin, Texas.1 Expanding access to this treatment provides patients timely access to this gold-standard treatment.

“With a limited availability of providers, thrombectomy is only available to 2 to 3 percent of eligible patients in the United States,” said Kelvin Hong, M.D., FSIR, associate professor and division chief of interventional radiology at Johns Hopkins University. “Patients don’t plan where and when they have a stroke. Our model of training board-certified interventional radiologists can expand access to quality, evidence-based care, and reduce the lifelong disability associated with stroke.”

Thrombectomy — a treatment that clears a clogged artery in the brain — increases the survival rates among those suffering an acute ischemic stroke, reduces the likelihood of resulting disabilities and speeds function recovery. However, to gain these benefits, thrombectomies must be initiated and performed quickly. Many hospitals do not have providers available to perform these treatments and must transfer patients to a facility where they can get this care, losing valuable time.

To determine an efficient and sustainable way to expand access to thrombectomy, researchers from Johns Hopkins University developed an interventional radiology stroke team at Suburban Hospital, a community hospital in Montgomery County, Md., a suburb of Washington, D.C. The team consisted of four interventional radiologists who were specially trained by a neurointerventional radiologist for six months. The entire team was available 24 hours a day, seven days a week, with the neurointerventional radiologist helicoptered to the hospital for every case during this training period.

“We looked to change the dynamic in stroke care, where instead of transporting medically fragile patients, we brought in a specialist to perform this care and build the infrastructure necessary to provide this treatment to a community with limited stroke care resources,” said Ferdinand Hui, M.D., a neurointerventional radiologist and associate professor of radiology and radiological science at Johns Hopkins University. “In a situation where every minute counts, we wanted to design our program to provide the training and organization necessary to bring 24/7 highly trained stroke interventionalists online as quickly as possible.”

Once the interventional radiologists were conducting the treatments independently, researchers measured the technical success of the thrombectomies performed by the newly trained physicians in 35 stroke cases using the Thrombolysis in Cerebral Infarction (TICI) scale. They found no significant differences compared to the 2016 HERMES meta-analysis2 of endovascular thrombectomy outcomes performed by other practitioners, such as neurointerventional radiologists and neurosurgeons. Additionally, 14 percent mortality in the first 90 days after the procedure was similar to 15.3 percent 90-day mortality among patients at stroke centers evaluated through the Journal of the American Medical Association-published HERMES trial.3 The median interval from symptom onset to the point when blood flow was restored was 325 minutes, compared to 285 minutes in previous research.

Researchers plan to further evaluate the technical outcomes and time metrics in a second-year study, with a goal of further reducing the time to treat each patient by improving efficiency and optimization year over year.

A limitation of the study may be in whether hospitals of varying sizes and resources can reproduce the program with the same outcomes. The research team plans to re-evaluate the program after two years of data collection.

For more information: www.sirmeeting.org

Related Stroke Content

VIDEO: Creating and Operating a Mobile Stroke Unit

Northwestern Medicine Mobile Stroke Unit Delivers Life-Saving Care 30 Minutes Sooner

 

References

1. Abstract 294: Technical Outcomes and Early Experience of a Centrifugally-Trained Interventional Radiology Stroke Service.  Huh E., Hui F., Bhagat N., et al. SIR Annual Scientific Meeting, March 23–28, 2019. www.sirmeeting.org.

2. Goyal M., Menon B.K., van Zwam W.H., et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. The Lancet, April 23, 2016. 

3. Saver J.L., Goyal M., van der Lugt A., et al. Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis. JAMA, Sept. 27, 2016. doi:10.1001/jama.2016.13647

Related Content

Henry Ford Hospital's ViewRay MRIdian linear accelerator system allows real-time MRI-guided radiotherapy. Shown is the support staff for this system. In the center of the photo is Benjamin Movsas, M.D., chair of radiation oncology at Henry Ford Cancer Institute. Second from the right is Carrie Glide-Hurst, Ph.D., director of translational research, radiation oncology.

Henry Ford Hospital's ViewRay MRIdian linear accelerator system allows real-time MRI-guided radiotherapy. Shown is the support staff for this system. In the center of the photo is Benjamin Movsas, M.D., chair of radiation oncology at Henry Ford Cancer Institute. Second from the right is Carri Glide-Hurst, Ph.D., director of translational research, radiation oncology.

Feature | Henry Ford Hospital | May 21, 2019 | Dave Fornell, Editor
Henry Ford Hospital thought leaders regularly speak at the radiation oncology and radiology conferences about new res
MaxQ AI Launches Accipio Ax Slice-Level Intracranial Hemorrhage Detection
Technology | Computer-Aided Detection Software | May 21, 2019
Medical diagnostic artificial intelligence (AI) company MaxQ AI announced that Accipio Ax will begin shipping in August...
Philips Launches IntraSight Interventional Applications Platform
Technology | Interventional Radiology | May 20, 2019
Philips announced the launch of the new IntraSight interventional applications platform. The secure, application-based...
Brain images that have been pre-reviewed by the Viz.AI artificial intelligence software to identify a stroke. The software automatically sends and alert to the attending physician's smartphone with links to the imaging for a final human assessment to help speed the time to diagnosis and treatment. Depending on the type of stroke, quick action is needed to either activate the neuro-interventional lab or to administer tPA. Photo by Dave Fornell.

Brain images that have been pre-reviewed by the Viz.AI artificial intelligence software to identify a stroke. The software automatically sends and alert to the attending physician's smartphone with links to the imaging for a final human assessment to help speed the time to diagnosis and treatment. Depending on the type of stroke, quick action is needed to either activate the neuro-interventional lab or to administer tPA. Photo by Dave Fornell.

Feature | Artificial Intelligence | May 17, 2019 | Inga Shugalo
With its increasing role in medical imaging,...
Netherlands Hospital to Install State-of-the-Art MRI Ablation Center
News | Magnetic Resonance Imaging (MRI) | May 13, 2019
Imricor announced the signing of a commercial agreement with the Haga Hospital in The Hague, Netherlands to outfit a...
Clinical Trial Explores Opening Blood-Brain Barrier in Fight Against Alzheimer's

Vibhor Krishna, M.D., (right) fits David Shorr with a helmet-like device used in a new clinical trial for Alzheimer’s disease at The Ohio State University Wexner Medical Center. The device uses MRI-guided imaging to deliver focused ultrasound to specific areas of the brain to open the blood-brain barrier. Image courtesy of Ohio State University Wexner Medical Center.

News | Focused Ultrasound Therapy | May 09, 2019
May 9, 2019 — A new clinical trial at The Ohio State University Wexner Medical Center and two other sites is testing
Ultrasonic Device Safe and Effective for Lung Vessel Sealing in Minimally Invasive Lobectomy
News | Interventional Radiology | May 06, 2019
According to a new study, an ultrasonic vessel-sealing device can improve patient outcomes by reducing the incidence of...
360 degree view inside an Interventional radiology lab at Henry Ford Hospital used for neuro-interventions and stroke.
360 Photos | 360 View Photos | May 06, 2019
This is a 360 degree photo view inside the neuro-interventional radiology lab at ...
Multisociety Position Statement Endorses Prostatic Artery Embolization
News | Interventional Radiology | May 02, 2019
A new position statement from interventional radiology professional societies in the U.S. and Europe states that...