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Standards of Practice in Acute Ischemic Stroke Intervention International Recommendations

  • Laurent Pierot (a1), Mahesh Jarayaman (a2), Istvan Szikora (a3), Joshua Hirsch (a4), Blaise Baxter (a5), Shigeru Miyachi (a6), Jeyaledchumy Mahadevan (a7), Winston Chong (a8), Peter J. Mitchell (a9), Alan Coulthard (a10), Howard A. Rowley (a11), Pina C. Sanelli (a12), Donatella Tampieri (a13), Patrick Brouwer (a14), Jens Fiehler (a15), Naci Kocer (a16), Pedro Vilela (a17), Alex Rovira (a18), Urs Fischer (a19), Valeria Caso (a20), Bart van der Wort (a21), Nobuyuki Sakai (a22), Yuji Matsumaru (a23), Shin-ichi Yoshimura (a24), Luisa Biscoito (a25), Manuel Pumar (a26), Orlando Diaz (a27), Justin Fraser (a28), Italo Lifante (a29), David S. Liebeskind (a30), Raul G. Nogueira (a31), Werner Hacke (a32), Michael Brainin (a33), Bernard Yan (a34), Michael Soderman (a14), Allan Taylor (a35), Sirintara Pongpech (a36) and Karel Terbrugge (a37)...

Abstract:

After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.

Les normes de pratique recommandées à l’échelle internationale lors d’interventions consécutives à un accident ischémique cérébral aigu. En octobre 2017, à Budapest, une rencontre pluridisciplinaire de spécialistes s’est organisée dans le cadre du 17e congrès de la World Federation of Interventional and Therapeutic Neuroradiology. Cette rencontre portait sur l’établissement de normes relatives aux interventions consécutives à des accidents ischémiques aigus. Elle a eu lieu, précisons-le, après que cinq essais randomisés contrôlés (ERC) ont montré les avantages de la thrombectomie mécanique dans la prise en charge de patients victimes d’un accident ischémique cérébral aigu montrant des signes naissants d’occlusion des plus gros vaisseaux sanguins. Les normes dont il a été alors question visaient aussi à atteindre un consensus quant aux exigences minimales auxquelles devaient se conformer les établissements de santé offrant la thrombectomie mécanique. Dans l’idéal, tous les patients devraient être traités dans un établissement offrant un éventail complet de soins neuro-endovasculaires (de niveau 1). Toutefois, en raison de l’éloignement géographique, quelques patients demeurent incapables de se rendre dans un tel établissement dans des délais raisonnables. Dans cette optique, le groupe réuni à Budapest a défini de façon particulière des recommandations définissant les aspects permettant aux autres établissements (de niveau 2) d’organiser en amont des soins en thrombectomie destinés à des patients victimes d’accidents ischémiques cérébraux aigus mais pas d’autres maladies neurovasculaires. Enfin, d’autres établissements (de niveau 3) pourront compter sur une unité de traitement des AVC, notamment au moyen de la thrombolyse intraveineuse; toutefois, ils ne pourront offrir aucune autre thérapie endovasculaire. Réunis, l’ensemble de ces établissements de niveaux 1, 2 et 3 constitue un réseau complet de soins destinés aux patients victimes d’un AVC. Le groupe multidisciplinaire réuni lors de cette rencontre a ainsi élaboré des recommandations et un cadre de référence visant le développement de la thrombectomie dans le monde entier.

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Copyright

Corresponding author

Correspondence to: Karel Terbrugge, Toronto Western Hospital, 399 Bathurst Street, Toronto M5T 2S8, Canada. Email: karel.terbrugge@uhn.ca

References

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Canadian Journal of Neurological Sciences
  • ISSN: 0317-1671
  • EISSN: 2057-0155
  • URL: /core/journals/canadian-journal-of-neurological-sciences
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