Endovascular Stroke Therapy Results Improve over Time: The ‘Learning Curve' at a New Comprehensive Stoke Center

作者：Ethan A. Benardete, Anil K. Nair · 发表于：Cerebrovascular Diseases Extra · 年份：2015 · DOI：10.1159/000370060 · 被引用次数：2553 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: The requirements for a comprehensive stroke center (CSC) include the capability to perform endovascular stroke therapy (EST). EST is a complex process requiring early identification of appropriate patients and effective delivery of intervention. In order to provide prompt intervention for stroke, CSCs have been established away from large academic centers in community-based hospitals. We hypothesized that quantifiable improvements would occur during the first 2 years of a community-based CSC as the processes and personnel evolved. We report the results over time of EST at a new community-based CSC. METHODS: We have retrospectively analyzed demographic data and outcome metrics of EST from the initiation phase of a new community-based CSC. Data was divided into year 1 and year 2. Statistical analysis (Student's t test and Fisher's exact test) was performed to compare the patient population and outcomes across the two time periods. Outcome variables included the thrombolysis in cerebral infarction (TICI) score, a change in the NIH stroke scale score and the modified Rankin Scale (mRS) score. Analysis of variance (ANOVA) was used to statistically analyze the relationship between population variables and outcome. Computed tomography (CT) angiography and CT perfusion analysis were used to select patients for EST. Approximately half of the patients undergoing EST were excluded from receiving intravenous recombinant tissue plasminogen activator (IV rt-PA) by standard crit...