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Setting Up a Stroke Team Algorithm and Conducting Simulation-based Training in the Emergency Department - A Practical Guide
Published on: January 15, 2017
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Visual aid tool to improve decision making in acute stroke care
Gustavo Saposnik1,2, Mayank Goyal3, Charles Majoie4
11 Stroke Outcomes Research Unit, ( www.sorcan.ca ) Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada.
Summary
Endovascular thrombectomy significantly improves outcomes for acute ischemic stroke patients with large vessel occlusion. This visual tool aids clinicians in decision-making, showing increased independence and early recovery rates.
Area of Science:
- Neurology
- Interventional Cardiology
- Medical Decision Making
Background:
- Acute ischemic stroke management presents significant clinical challenges.
- Endovascular therapy has demonstrated clear benefits in recent randomized trials.
- Effective decision support tools are needed for clinicians regarding endovascular intervention.
Purpose of the Study:
- To develop a visual aid tool (Cates' plots) for guiding clinical decisions on endovascular thrombectomy in acute ischemic stroke.
- To represent pooled data from five randomized controlled trials (RCTs) on endovascular thrombectomy outcomes.
Main Methods:
- Utilized Cates' plots to visualize comparative benefits of standard care versus endovascular thrombectomy.
- Analyzed pooled data from 1287 patients (634 thrombectomy, 653 control) from five RCTs.
- Visualized key outcomes including functional independence (mRS 0-2), excellent recovery (mRS 0-1), early neurological recovery, and revascularization.
Main Results:
- For every 100 patients, endovascular thrombectomy resulted in 49 achieving independence (mRS 0-2) versus 27 for standard care.
- Early neurological recovery was achieved by 54 patients per 100 with thrombectomy, compared to 21 with standard care.
- Subgroup analyses included time to treatment and baseline stroke severity.
Conclusions:
- Cates' plots effectively assist clinicians and patients in visualizing and comparing potential outcomes.
- Endovascular thrombectomy offers substantial benefits, leading to 22 additional patients achieving independence and 33 more achieving early neurological recovery per 100 treated individuals.
