Integrated Stroke System Model Expands Availability of Endovascular Therapy While Maintaining Quality Outcomes

Area of Science:

• Neurology
• Vascular Surgery
• Health Systems Management

Background:

• Optimal care delivery for endovascular stroke therapy (EVT) remains undefined.
• An integrated stroke system (ISS) was developed to enhance EVT accessibility regionally.
• The system aimed to maintain high hospital and physician quality standards.

Purpose of the Study:

• To evaluate the impact of an integrated stroke system (ISS) on EVT availability and treatment times.
• To assess the quality metrics associated with EVT in a decentralized system.
• To validate the ISS model using external regional data.

Main Methods:

• Retrospective analysis of 513 patients with large vessel occlusion acute ischemic stroke treated with EVT (Jan 2014-Feb 2019).
• Implementation of ISS in Oct 2017, expanding EVT-Performing Hospitals (EPHs) to four.
• Comparison of pre-ISS and post-ISS cohorts, focusing on onset-to-arrival time and quality outcomes.

Main Results:

• ISS implementation reduced time from stroke onset to EPH arrival by 40 minutes and onset to groin puncture by 29 minutes.
• Interhospital transfer rates decreased post-ISS (46% vs. 37%).
• Quality metrics (hemorrhage, TICI 2b/3, 90-day mRS) were comparable across EPHs, irrespective of volume.

Conclusions:

• Expanding EVT availability through an ISS significantly decreases treatment times for acute ischemic stroke.
• The ISS model effectively supports quality care delivery in lower-volume hospitals.
• This integrated approach provides a viable framework for regional stroke care optimization.