The impact of evidence: evolving therapy for acute ischemic stroke in a large healthcare system.
BACKGROUND
With a recent surge of clinical trials, the treatment of ischemic stroke has undergone dramatic changes.


OBJECTIVE
To evaluate the impact of evidence and a revamped stroke protocol on a large healthcare system.


METHODS
A retrospective review of 69 patients with ischemic stroke treated with intra-arterial therapy was carried out. Cohort 1 included patients treated before implementation of a new stroke protocol, and cohort 2 after implementation. Angiographic outcome was graded using the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcomes were assessed using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).


RESULTS
Primary outcomes comparing cohorts demonstrated decreased arrival-to-puncture time (cohort 2: 104 vs cohort 1: 181 min, p<0.001), similar TICI 2b/3 rates (86.5% vs 81.3%, p=0.5530), and similar percentage of patients with discharge mRS 0-2 (18.9% vs 21.9%, p=0.7740). Notable secondary outcomes for cohort 2 included decreased puncture-to-first pass time (34 vs 53 min, p <0.001), increased TICI 3 rates (37.8% vs 18.8%, p=0.0290), a trend toward greater improvements in NIHSS on postoperative day 1 (6.8 vs 2.6, p=0.0980) and discharge (9.5 vs 6.7, p=0.1130), and a trend toward increased percentage of patients discharged with mRS 0-3 (48.6% vs 34.4%, p=0.3280 NS). There were similar rates of symptomatic intracerebral hemorrhage (10.8% vs 9.4%, p=0.9570) and death (10.8% vs 15.6%, p=0.5530).


CONCLUSIONS
An interdisciplinary and rapid response to the emergence of strong clinical evidence can result in dramatic changes in a large healthcare system.
['Mascitelli|Justin R|JR|', 'Wilson|Natalie|N|', 'Shoirah|Hazem|H|', 'De Leacy|Reade A|RA|', 'Furtado|Sunil V|SV|', 'Paramasivam|Srinivasan|S|', 'Oermann|Eric K|EK|', 'Mack|William J|WJ|', 'Tuhrim|Stanley|S|', 'Dangayach|Neha S|NS|', 'Meyer|Stephan A|SA|', 'Bederson|Joshua B|JB|', 'Mocco|J|J|', 'Fifi|Johanna T|JT|']
D000368:Aged D002545:Brain Ischemia D015331:Cohort Studies D003695:Delivery of Health Care D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010351:Patient Discharge D012189:Retrospective Studies D020521:Stroke D017131:Thrombectomy D016896:Treatment Outcome
Stroke Thrombectomy