Systematic review of organizational models for intra-arterial treatment of acute ischemic stroke

Abstract

Background

Intra-arterial treatment of acute ischemic stroke requires changes to acute stroke services since most hospitals do not have on-site intra-arterial treatment facilities.

Aim

To identify models for delivery of intra-arterial treatment and to compare process performance and clinical and radiological outcomes of the different models.

Methods

We systematically searched the literature and contacted experts in the field. We performed a qualitative synthesis to identify models, and a quantitative review and meta-analysis of clinical and radiological outcomes under different organizational models.

Summary of review

The searches retrieved 148 publications, of which 27 were used for the identification and description of models, and 9 for the comparison of the different models. We identified four main models: the mother-ship, drip-and ship, mobile interventionist, and mobile stroke unit models. There were no randomized-controlled trials of the different models, but non-randomized comparisons were possible using data from 8 observational studies and 1 randomized-controlled trial of intra-arterial therapy, of a total of 4127 patients. Comparison between the mother-ship and drip-and-ship models showed no difference in survival (OR 0.81; 95% CI 0.63–1.03), favorable functional outcome (OR 0.96; 95% CI 0.73–1.25), or arterial patency (OR 0.89; 95% CI 0.73–1.08).

Conclusions

Different organizational models exist for intra-arterial treatment of acute ischemic stroke, but there is insufficient evidence to recommend a particular, universal model. Until one model can be shown to be superior, the choice of model should depend on local factors and patient characteristics.

Keywords

Emergency medical services patient transfer ischemic stroke thrombectomy endovascular treatment thrombolysis review

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References

Badhiwala

Nassiri

Alhazzani

et al.

Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA 2015; 314: 1832–1843.

Chen

Ding

Starke

et al.

Endovascular vs medical management of acute ischemic stroke. Neurology 2015; 85: 1980–1990.

Elgendy

Kumbhani

Mahmoud

Bhatt

Bavry

. Mechanical thrombectomy for acute ischemic stroke: a meta-analysis of randomized trials. J Am Coll Cardiol 2015; 66: 2498–2505.

Fargen

Neal

Fiorella

Turk

Froehler

Mocco

. A meta-analysis of prospective randomized controlled trials evaluating endovascular therapies for acute ischemic stroke. J Neurointerv Surg 2015; 7: 84–89.

Hong

Lee

Rha

. Endovascular recanalization therapy in acute ischemic stroke: updated meta-analysis of randomized controlled trials. J Stroke 2015; 17: 268–281.

Yarbrough

Ong

Beyer

Lipsey

Derdeyn

. Endovascular thrombectomy for anterior circulation stroke: systematic review and meta-analysis. Stroke 2015; 46: 3177–3183.

Goyal

Menon

van Zwam

et al.

Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016; 387: 1723–1731.

Wahlgren

Moreira

Michel

et al.

Mechanical thrombectomy in acute ischemic stroke: consensus statement by ESO-Karolinska Stroke Update 2014/2015, supported by ESO, ESMINT, ESNR and EAN. Int J Stroke 2016; 11: 134–147.

Fiehler

Cognard

Gallitelli

et al.

European recommendations on organisation of interventional care in acute stroke EROICAS. Int J Stroke 2016; 11: 701–716.

10.

Powers

Rabinstein

Ackerson

et al.

2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49: e46–e110.

11.

Stroup

Berlin

Morton

et al.

Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of observational studies in epidemiology MOOSE group. JAMA 2000; 283: 2008–2012.

12.

Higgins

Thompson

. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–1558.

13.

Rymer

Thurtchley

Summers

. America Brain and Stroke Institute Stroke Team. Expanded modes of tissue plasminogen activator delivery in a comprehensive stroke center increases regional acute stroke interventions. Stroke 2003; 34: e58–e60.

14.

Silverman

Beland

Chhabra

McCullough

. The “drip-and-ship” approach: starting IV t-PA for acute ischemic stroke at outside hospitals prior to transfer to a regional stroke center. Conn Med 2005; 69: 613–620.

15.

Pervez

Silva

Masrur

et al.

Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke 2010; 41: e18–e24.

16.

Pfefferkorn

Holtmannspotter

Schmidt

et al.

Drip, ship, and retrieve: cooperative recanalization therapy in acute basilar artery occlusion. Stroke 2010; 41: 72–2726.

17.

Martin-Schild

. Commentary on “Patient Selection for Drip and Ship Thrombolysis in Acute Ischemic Stroke”. South Med J 2015; 10: 399–400.

18.

Qureshi

Chaudhry

Rodriguez

Suri

Lakshminarayan

Ezzeddine

. Outcome of the ‘Drip-and-Ship’ paradigm among patients with acute ischemic stroke: results of a statewide study. Cerebrovasc Dis Extra 2012; 2: 1–8.

19.

Walter

Kostopoulos

Haass

et al.

Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol 2012; 11: 397–404.

20.

Tekle

Chaudhry

Hassan

Rodriguez

Suri

Qureshi

. Drip-and-ship thrombolytic treatment paradigm among acute ischemic stroke patients in the United States. Stroke 2012; 43: 1971–1974.

21.

Ciccone

Valvassori

Nichelatti

et al.

Endovascular treatment for acute ischemic stroke. N Engl J Med 2013; 368: 904–913.

22.

Mansoor

Zand

Al-Wafai

Wahba

Giraldo

. Safety of a “drip and ship” intravenous thrombolysis protocol for patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2013; 22: 969–971.

23.

Ebinger

Winter

Wendt

et al.

Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. JAMA 2014; 311: 1622–1631.

24.

Cha

Nah

Kang

et al.

Outcomes after tissue plasminogen activator administration under the drip and ship paradigm may differ according to the regional stroke care system. J Stroke Cerebrovasc Dis 2014; 23: 160–163.

25.

Abilleira

Cardona

Ribo

et al.

Outcomes of a contemporary cohort of 536 consecutive patients with acute ischemic stroke treated with endovascular therapy. Stroke 2014; 45: 1046–1052.

26.

Campbell

Mitchell

Kleinig

et al.

Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018.

27.

Goyal

Demchuk

Menon

et al.

Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030.

28.

Saver

Goyal

Bonafe

et al.

Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295.

29.

Sheth

Smith

Grau-Sepulveda

Kleindorfer

Fonarow

Schwamm

. Drip and ship thrombolytic therapy for acute ischemic stroke: use, temporal trends, and outcomes. Stroke 2015; 46: 732–739.

30.

Weber

Reimann

Weimar

et al.

Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy. Ther Adv Neurol Disord 2016; 9: 79–84.

31.

Perez de la Ossa

Abilleira

Dorado

et al.

Access to endovascular treatment in remote areas: analysis of the reperfusion treatment registry of Catalonia. Stroke 2016; 47: 1381–1384.

32.

Park

Lee

Park

et al.

Characteristics of the drip-and-ship paradigm for patients with acute ischemic stroke in South Korea. J Stroke Cerebrovasc Dis 2016; 25: 2678–2687.

33.

Park

Yoon

Kim

et al.

Drip, ship, and on-demand endovascular therapy for acute ischemic stroke. PLoS One 2016; 11: e0150668.

34.

Alonso de Lecinana

Fuentes

Ximenez-Carrillo

et al.

A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience. Eur J Neurol 2016; 23: 297–303.

35.

Hiyama

Yoshimura

Shirakawa

et al.

Safety and effectiveness of drip, ship, and retrieve paradigm for acute ischemic stroke: a single center experience. Neurol Med Chir Tokyo 2016; 56: 731–736.

36.

Wei

Oxley

Nistal

et al.

Mobile interventional stroke teams lead to faster treatment times for thrombectomy in large vessel occlusion. Stroke 2017; 48: 3295–3300.

37.

Rinaldo

Brinjikji

McCutcheon

et al.

Hospital transfer associated with increased mortality after endovascular revascularization for acute ischemic stroke. J Neurointerv Surg 2017; 91: 1166–1172.

38.

Gerschenfeld

Muresan

Blanc

et al.

Two paradigms for endovascular thrombectomy after intravenous thrombolysis for acute ischemic stroke. JAMA Neurol 2017; 74: 549–556.

39.

Froehler

Saver

Zaidat

et al.

Interhospital Transfer prior to thrombectomy is associated with delayed treatment and worse outcome in the STRATIS registry. Circulation 2017; 13: 2311–2321.

40.

Jovin

Chamorro

Cobo

et al.

Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296–2306.

41.

Berkhemer

Fransen

Beumer

et al.

A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20.

42.

Broderick

Palesch

Demchuk

et al.

Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013; 368: 893–903.

43.

Kidwell

Jahan

Gornbein

et al.

A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013; 368: 914–923.

44.

Nogueira

Jadhav

Haussen

et al.

Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 2018; 378: 11–21.

45.

Albers

Marks

Kemp

et al.

Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 2018; 378: 708–718.

46.

Strbian

Ahmed

Wahlgren

et al.

Trends in door-to-thrombolysis time in the safe implementation of stroke thrombolysis registry: effect of center volume and duration of registry membership. Stroke 2015; 46: 1275–1280.

47.

Holodinsky

Williamson

Kamal

Mayank

Hill

Goyal

. Drip and ship versus direct to comprehensive stroke center: conditional probability modeling. Stroke 2017; 48: 233–238.

48.

Milne

Holodinsky

Hill

et al.

Drip ‘n ship versus mothership for endovascular treatment: modeling the best transportation options for optimal outcomes. Stroke 2017; 48: 791–794.

49.

American Heart Association/American Stroke Association. Severity-Based Stroke Triage Algorithm for EMS, www.heart.org/mission-lifelinestroke (accessed 19 April 2018).

50.

Perez de la Ossa

Carrera

Gorchs

et al.

Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke 2014; 45: 87–91.

51.

Carrera

Campbell

Cortes

et al.

Predictive value of modifications of the prehospital rapid arterial occlusion evaluation scale for large vessel occlusion in patients with acute stroke. J Stroke Cerebrovasc Dis 2017; 26: 74–77.

52.

McMullan

Katz

Broderick

Schmit

Sucharew

Adeoye

. Prospective prehospital evaluation of the Cincinnati Stroke Triage Assessment Tool. Prehosp Emerg Care 2017; 21: 481–488.

53.

Hastrup

Damgaard

Johnsen

Andersen

. Prehospital acute stroke severity scale to predict large artery occlusion: design and comparison with other scales. Stroke 2016; 47: 1772–1776.

54.

Lima

Silva

Furie

et al.

Field assessment stroke triage for emergency destination: a simple and accurate prehospital scale to detect large vessel occlusion strokes. Stroke 2016; 47: 1997––2002.

55.

Scheitz

Abdul-Rahim

MacIsaac

et al.

Clinical selection strategies to identify ischemic stroke patients with large anterior vessel occlusion: results from SITS-ISTR safe implementation of thrombolysis in stroke international stroke thrombolysis registry. Stroke 2017; 48: 290–297.

56.

Vaclavik

Bar

Klecka

Holes

Cabal

Mikulik

. Prehospital stroke scale FAST PLUS Test predicts patients with intracranial large vessel occlusion. Brain Behav 2018; August: e01087.

57.

Pérez de la Ossa N, Ribó M. RACECAT: a trial comparing transfer to the closest local stroke center vs. direct transfer to endovascular stroke center of acute stroke patients with suspected large vessel occlusion in the Catalan territory, https://clinicaltrials.gov/ct2/show/study/NCT02795962 (accessed 13 August 2018).