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  • Initiation of a Neurosurgeon-Led Comprehensive Stroke Center: Review of Endovascular Stroke Therapy

    Final Number:

    Ethan A. Benardete MD PhD; Anil Karunakaran Nair MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: The requirements for a comprehensive stroke center (CSC) include the ability to perform endovascular stroke therapy (EST). The processes and procedures required to effectively intervene in ischemic stroke patients are complex. We hypothesized that outcomes of EST would improve over time in the start-up phase of a new CSC.

    Methods: We retrospectively reviewed demographic and outcome data from patients treated at a new CSC. Demographic data collected included (but was not limited to) age, sex, smoking history, hypertension, and prior stroke. Outcome data was divided into Year 1 and Year 2 subcategories and statistical analysis was applied to compare each group. For continuous data, students two-tailed t-test was used. Otherwise, ANOVA or Chi-square tests were applied.

    Results: Demographic data was similar between year 1 and year 2. There were statistically significant improvements in door-to-needle time for delivery of IV-rtPA. Door-to-intervention time also decreased, but it was not statistically significant . There were trends in improved outcome sincluding decreased mortality (36% vs. 14%), decreased complication rates (36% vs. 14%), and improved modified Rankin score at discharge. ANOVA analysis also demonstrated that age was statistically associated with higher mortality, while improved TICI score was associated with better outcomes.

    Conclusions: The initiation of a CSC is a complex undertaking that requires establishment of processes and protocols. At the same time, procedural techniques need improvement. All of these variable can affect outcome. Our data suggest that over time improvements do occur in both process and technical variables. However, even in the earliest stages, EST appears safe in a neurosurgeon-driven CSC.

    Patient Care: We will identify opportunities for improving endovascular stroke therapy.

    Learning Objectives: Analyze the outcomes of a CSC in the start-up phase


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