Endovascular treatment has recently become the recommended therapy for acute stroke after the publication of five randomized trials (MR CLEAN1, ESCAPE2, EXTEND IA3, SWIFT PRIME4, REVASCAT5) in 2015 that demonstrate its efficacy. Hospitals need to adapt to these updated stroke care guidelines, and many hospitals are not appropriately equipped for neurointerventional procedures. Decreased time to treatment is associated with favorable clinical outcomes, and best practices to optimize workflow between comprehensive stroke centers and secondary hospitals have become an important area of study. This prospective study is being conducted on acute stroke cases within the Mount Sinai Health System from 1 June 2016 up until 31 December 2018. The researchers would like to evaluate how variable methods of interventional service delivery for acute stroke affect clinical measures and outcomes.
More specifically, the researchers are conducting this study in order to determine whether outcomes of neurointervention for large vessel occlusion in stroke, for patients presenting to and receiving treatment at a comprehensive stroke center, will be superior to that delivered by a mobilized intervention team at a central satellite hospital. In particular, the hypothesis is that factors affecting outcome include presentation to secondary hospital, delays with transfer including traffic conditions and time of day, and the acquisition of complex imaging within secondary hospitals.
- Acute Endovascular Stroke Treatment Other
Other Names: Solitaire; Trevo; Embotrap; Medtronic; Stryker; Neuravi; Penumbra; Microvention ARM 1: Kind: Experimental Label: Mobilized Neurointervention Team Description: Patients undergoing endovascular stroke interventions. ARM 2: Kind: Experimental Label: Mobilized Patient ARM 3: Kind: Experimental Label: Core Comprehensive Stroke Center Treatment
Patients who consent to the study and present with acute stroke treated with thrombectomy in the Mount Sinai Health System.
|Type||Measure||Time Frame||Safety Issue|
|Primary||Treatment times||90 days|
|Secondary||Time to groin puncture procedure||3 months|
|Secondary||Time of EMS contact to groin puncture||90 days|
|Secondary||modified Rankin Scale (mRS)||90 days|
Biospecimen Retention:Samples With DNA - Blood Clot; Saliva