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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Evolution of a US County System for Acute Comprehensive Stroke Care.

Radoslav I Raychev1,2, Dana Stradling3, Nirav Patel4

  • 1From the Saddleback Memorial Medical Center, Laguna Hills, CA (R.I.R.).

Stroke
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Emergency Medical Services in Orange County improved acute stroke care, with reperfusion therapy reaching 29.2% of ischemic stroke patients. Endovascular treatment rates significantly increased over time, enhancing patient outcomes.

Keywords:
demographymortalityneurologyreperfusionstroke

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Area of Science:

  • Neurology
  • Emergency Medicine
  • Public Health

Background:

  • Orange County, California, utilizes a tiered stroke system (hubs/spokes) for acute stroke care.
  • Stroke receiving centers are designated based on endovascular treatment capabilities.

Purpose of the Study:

  • To examine stroke details, reperfusion therapies, and hospital transfers.
  • To analyze changes in acute stroke care over time.

Main Methods:

  • Evaluated patients with suspected acute stroke from January 1, 2013, to December 31, 2015.
  • Assessed patients with 911 calls within 7 hours of stroke onset.

Main Results:

  • 64% of suspected strokes were confirmed; 74% were ischemic.
  • Reperfusion therapy was administered to 29.2% of ischemic stroke patients (21.7% IV tPA, 7.5% endovascular).
  • Endovascular treatment rates more than doubled from 5.6% to 12.5% between 2013 and 2015.

Conclusions:

  • The stroke care system demonstrates positive trends, with increased reperfusion and endovascular treatment rates.
  • Ongoing optimization efforts should focus on improving access to advanced stroke therapies.