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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Changes in Patient Volumes and Outcomes After Adding Thrombectomy Capability.

Minerva H Zhou¹, Akash P Kansagra^2,3,4

¹School of Medicine (M.H.Z.), Washington University, St. Louis, MO.

|April 19, 2021

Summary

Adding endovascular thrombectomy (EVT) capability to stroke centers increases patient and treatment volumes. However, the overall population health improvement is modest, requiring careful consideration of hospital and patient benefits.

Keywords:

hospitals humans population health probability thrombectomy

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Area of Science:

Neurology
Health Services Research
Medical Simulation

Background:

Rising demand for endovascular thrombectomy (EVT).
Introduction of thrombectomy-capable stroke centers (TSC).
Interest in adding EVT capability to existing stroke centers to attract referrals.

Purpose of the Study:

Quantify changes in patient volumes and outcomes when adding EVT capability to an existing stroke center.
Evaluate the impact of EVT capability on stroke care delivery in different settings.

Main Methods:

Simulated a 3-center system (1 TSC, 2 primary stroke centers) using MATLAB 2017a Simulink.
Modeled urban and rural geographic settings with Nearest Center and Bypass routing paradigms.
Determined probability of good clinical outcome based on treatment type and timing.

Main Results:

Bypass model: 40.1% increase in total stroke patient volume and 31.2-31.9% increase in acute stroke treatments at the TSC.
Nearest Center model: No change in total stroke patient volume, but 9.3-9.5% increase in acute stroke treatments at the TSC.
Modest absolute increase in good clinical outcomes (0.2-0.6% population-wide, 0.3-1.8% at TSC).

Conclusions:

Adding EVT capability shifts patient and treatment volume to the TSC.
The changes yield modest improvements in overall population health.
Health systems must weigh hospital and patient benefits when deciding to add EVT capability.