Prehospital care delivery and triage of stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of Neurointerventional Surgery
| Autor: | Don Heck, Chirag D. Gandhi, Blaise Baxter, Sameer A. Ansari, Mahesh V Jayaraman, J Mocco, G. Lee Pride, Joshua A Hirsch, Peter A. Rasmussen, Todd Abruzzo, Donald Frei, Raymond L. Fowler, Josser E Delgado Almandoz, Ryan A McTaggart, M. Shazam Hussain, Robert M. Starke, Rishi Gupta, William J. Mack, Charles J. Prestigiacomo, Michael Chen, Seon Kyu Lee, Mark J. Alberts, Steven W. Hetts, Richard P. Klucznik, Peter Sunenshine, J. Neal Rutledge, Barb Albani, Thabele M Leslie-Mazwi, Philip M. Meyers, Justin F. Fraser, Athos Patsalides, Adam S Arthur, Ketan R. Bulsara |
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| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Embolectomy General Medicine Evidence-based medicine 030204 cardiovascular system & hematology medicine.disease Triage Tissue plasminogen activator Surgery 03 medical and health sciences 0302 clinical medicine medicine Interdisciplinary communication cardiovascular diseases Neurology (clinical) Intensive care medicine business Stroke 030217 neurology & neurosurgery Endovascular recanalization techniques medicine.drug Large vessel occlusion |
| Zdroj: | Journal of neurointerventional surgery. 9(8) |
| ISSN: | 1759-8486 |
| Popis: | Recent randomized clinical trials1–5 established the superiority of endovascular recanalization techniques, specifically mechanical embolectomy, compared with best medical therapy alone for the treatment of patients with emergent large vessel occlusion (ELVO) stroke. ELVO stroke is defined as a stroke secondary to anterior circulation large vessel occlusion (LVO) of the internal carotid, middle cerebral (M1 segments) arteries documented by imaging, without large completed infarct and presenting within 6 hours of symptom onset.6 Given the overwhelming clinical evidence provided by these trials, recent American Heart Association (AHA) guidelines concluded that “embolectomy needs to be performed as rapidly as possible for the greatest clinical benefit, and is best when performed within 6 h from onset of symptoms” (AHA class I, level of evidence A).6 In addition, cost modeling derived from trial outcomes data and claims databases in the USA strongly suggests that cost-effectiveness and an overall societal benefit is associated with investment in access to these endovascular techniques.7 Rapid access to endovascular services depends upon optimization of prehospital stroke care and transport within stroke systems of care, focusing on the unique needs of patients with ELVO through their diagnostic investigation and treatment pathway. The Society of NeuroInterventional Surgery (SNIS) proposed process time metrics for ELVO stroke treatment, including door to IV tissue plasminogen activator (t-PA) of |
| Databáze: | OpenAIRE |
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