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Endovascular Thrombectomy Safe When Performed by Interventional Radiologists
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Endovascular thrombectomy in patients with acute ischemic stroke was safe when performed by trained interventional radiologists, and results were comparable to those seen with other specialties, according to findings presented at the Society of Interventional Radiology Annual Scientific Meeting.
“Depending on your region or geographic area, there are a limited number of thrombectomy providers, making thrombectomy access for all eligible patients a recognized problem,” Kelvin Hong, MD, FSIR, associate professor and division chief of interventional radiology at Johns Hopkins University, told Cardiology Today’s Intervention. “According to a Wall Street Journal analysis of Medicare data, thrombectomy is only available to 2% to 3% of the U.S. population. Patients don’t plan where and when they have a stroke. Our model of training board-certified interventional radiologists can expand access to quality, evidence-based care, and reduce the lifelong disability associated with stroke.”
The researchers developed a four-person team of interventional radiologists who learned best practices and were trained by a neurointerventional radiologist for 6 months.
“We looked to change the dynamic in stroke care, where instead of transporting medically fragile patients, we brought in a specialist to perform this care and build the infrastructure necessary to provide this treatment to a community with limited stroke care resources,” Ferdinand Hui, MD, a neurointerventional radiologist and associate professor of radiology and radiological science at Johns Hopkins University, said in a press release. “In a situation where every minute counts, we wanted to design our program to provide the training and organization necessary to bring 24/7 highly trained stroke interventionalists online as quickly as possible.”
The researchers then evaluated the team’s first 35 cases after the 6-month training period. The primary outcome was technical success as determined by the thrombolysis in cerebral infarction (TICI) scale. Secondary endpoints included 90-day mortality, intervention-related complications and temporal efficiency of procedural events. The results were compared with those from the HERMES meta-analysis of endovascular thrombectomy procedures performed by neurointerventional radiologists, neurosurgeons and other practitioners.
Among the cohort, 83% of procedures achieved TICI 3 or 2b technical success, which did not differ significantly from the rate reported in HERMES, Hong and colleagues found.
The rate of mortality at 90 days was 10%, similar to the rate of 15.3% observed in HERMES, according to the researchers.
There were no instances of intervention-related hematomas, intraparenchymal hemorrhages or arterial perforation or dissection, the researchers reported.
Median time from symptom onset to reperfusion was 325 minutes vs. 285 minutes reported in HERMES. – by Erik Swain
Reference:
Huh E, et al. Abstract 294. Presented at: Society of Interventional Radiology Annual Scientific Meeting; March 23-28, 2019; Austin, Texas.
Disclosures: Hong reports he has financial ties with AstraZeneca, Boston Scientific and BTG. Hui reports no relevant financial disclosures.
Editor’s Note: This article was updated on April 1, 2019 to reflect new data.