Related Experiment Video
Updated: Aug 26, 2025
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
12.1K
Reducing delay to endovascular reperfusion after relocating a thrombolysis unit
Nicolaj Grønbæk Laugesen1, Klaus Hansen1,2, Joan Højgaard1
1Department of Neurology, Stroke Center Rigshospitalet, Rigshospitalet, Copenhagen, Denmark.
Frontiers in Neurology
|October 10, 2022
Summary
Relocating intravenous thrombolysis (IVT) services to a mechanical thrombectomy (MT)-capable center significantly reduced reperfusion times for acute ischemic stroke patients. This organizational change improved patient outcomes by shortening delays without impacting prehospital transport.
Area of Science:
- Neurology
- Interventional Radiology
- Health Services Research
Background:
- Functional outcomes in acute ischemic stroke patients treated with mechanical thrombectomy (MT) are critically time-dependent.
- Delays in endovascular reperfusion negatively impact patient outcomes.
- Organizational strategies, such as relocating services, can potentially modify reperfusion times.
Purpose of the Study:
- To investigate the impact of relocating intravenous thrombolysis (IVT) services from a non-MT center to an MT-capable center on reperfusion times.
- To assess the association between reduced imaging-reperfusion times and functional outcomes in stroke patients.
Main Methods:
- Retrospective, single-center cohort study of 253 stroke patients treated with MT (2017-2019).
- Data divided into two periods: before (Period 1) and after (Period 2) IVT service relocation in 2018.
- Analysis of time intervals: ambulance-to-imaging and imaging-to-reperfusion; ordinal logistic regression used to analyze functional outcomes.
Main Results:
- No significant change in ambulance-imaging times (median 27 min vs. 30 min).
- Significant reduction in imaging-reperfusion times (median 173 min vs. 114 min, p < 0.001).
- Every 10-minute increase in imaging-reperfusion delay was associated with poorer 90-day functional outcome (aOR 0.95, 95% CI: 0.95-0.98).
Conclusions:
- Relocating IVT services to an MT-capable center effectively reduced reperfusion times without increasing prehospital delays.
- Optimizing the organization of IVT and MT services is crucial for improving patient outcomes in urban stroke care.
- Centralizing services streamlines the treatment pathway, leading to faster reperfusion and better functional recovery.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
18
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
18
01:28Acute Coronary Syndrome IV: Interprofessional Care
22
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
22
01:27Peripheral Artery Disease III: Interprofessional Care
22
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
22
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
35
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
35
01:16Clot Retraction and Fibrinolysis
6.8K
After a fibrin clot is formed, the next step is clot retraction, a vital process facilitated by platelet contractile proteins, such as actin and myosin. These proteins pull the fibrin strands closer together and condense the clot. This action reduces the size of the clot, creating a smaller, denser structure that effectively seals off the damaged vessel. Clot retraction consolidates the clot and helps with wound healing by bringing the edges of the damaged blood vessel closer together.
6.8K
01:22Aneurysm IV: Nursing Management
17
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
17