Availability of Endovascular Treatment for Stroke | Journal Scan

Study Questions:

What is the geographic availability of mechanical embolectomy services in California?


The authors identified all patients who were hospitalized for acute ischemic stroke at all nonfederal acute care hospitals in California from 2009 to 2010, and all hospitals that performed any mechanical embolectomy procedures by case volume during the same period. Geographic service areas around each hospital were calculated on the basis of prespecified ground transport distance thresholds. This was then used to calculate the proportion of hospitalized patients with stroke who lived within service areas for centers with low and high annualized volume of mechanical embolectomy procedures.


Over the 2-year study period, a small proportion (15%) of hospitals performed at least one mechanical embolectomy for acute stroke, but only 10 of the 360 hospitals performed >10 cases per year. Most hospitalized patients with stroke (94%) lived within a 2-hour transport time (65 miles) to a hospital that performed ≥1 procedure during the 2-year period. Approximately 93% of the patients with stroke who received mechanical embolectomy lived within 20 miles from an embolectomy-capable hospital.


In California, most patients with stroke lived within reasonable ground transport distances from centers that performed ≥1 mechanical embolectomy in a 2-year period.


Recent data demonstrate a remarkable benefit of endovascular treatment of stroke benefit (Goyal M, et al. N Engl J Med 2015;Feb 11:[Epub]) both in terms of morbidity, and mortality for large stroke. The study mandated and achieved rapid endovascular therapy, and it is likely that this speedy reperfusion was the key to the improved outcomes seen in that trial. Widespread clinical application of this approach requires creation of rapid care systems that can provide efficient and timely endovascular reperfusion for stroke. This current analysis suggests that most patients in California live close enough to centers that can provide embolectomy, and creation of rapid stroke treatment networks is feasible and should be the next logical step in stroke care.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Embolectomy, Endovascular Procedures, Stroke, Reperfusion, Hospitals, Vascular Diseases

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