A study, published in CardioVascular and Interventional Radiology, has investigated the possibility of collaboration between vascular interventional radiologists, diagnostic neuroradiologists and stroke neurologists for neurointerventional treatment of acute stroke as a strategy for centres lacking of specialised interventional neuroradiologists.
The study, led by Lars Fjetland, Department of Radiology, Stavanger University Hospital, Stavanger, Norway, and others aimed to “evaluate the safety and efficacy of neurointerventional procedures in acute stroke patients performed by vascular interventional radiologists in cooperation with diagnostic neuroradiologists and stroke neurologists and compare the results with those of previous reports from centres with specialised interventional neuroradiologists.”
The current literature on acute ischaemic stroke treatment with neurointerventional procedures such as intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA), intra-arterial thrombolysis or mechanical thrombectomy, according to Fjetland et al, “comes mostly from high volume stroke centres, and the treatment is performed by interventional neuroradiologists.” However, the authors wrote, quoting Hirsh JA et al (J Neurointerv Sur; 1:27-31) “The availability of these centres and specialists is limited and not sufficient to give the population an equal offer of invasive stroke treatment.”
This study shows the experience of a university medical centre serving a population of approximately 330,000 inhabitants where invasive reperfusion is performed by vascular interventional radiologists in collaboration with diagnostic neuroradiologists and stroke neurologists, the authors wrote.
Thirty nine patients with acute ischaemic stroke who were not eligible for first-line intravenous thrombolysis were included in the study, from May 2009 to October 2011. The patients were treated with intra-arterial thrombolysis (Penumbra system) or mechanical thrombectomy (Solitaire FR thrombectomy system, eV3/Covidien). All patients underwent cerebral computed tomography (CT) and: “The decision about endovascular treatment was made by a team consisting of the treating stroke neurologist, a vascular interventional radiologist, and a diagnostic neuroradiologist,” the authors wrote. Five experienced vascular interventional radiologists performed the endovascular treatments.
According to the results, 14 patients (35.9%) had a good clinical outcome (mRS score ≤2) at 90 days post-procedure of which 10 patients were treated with the Penumbra system, one with the Solitaire FR, two with intra-arterial thrombolysis and one with guidewire/catheter manipulation. Eight patients (32%) with middle cerebral artery occlusion, three with basilar occlusion (50%) and three with (50%) with tandem lesions had good clinical outcome with an overall pre-procedure rate of 5.1%.
The results also showed that nine patients (22.5%) died during the first 90 days after treatment, six of them were >80 years old, and two died from cerebrovascular causes.
“In this study, we found that endovascular stroke treatment performed by interventional radiologists, working in close cooperation with diagnostic neuroradiologists and neurologists, appears to be a safe and feasible method of treating this devastating disorder,” said Fjetland et al.
The authors commented: “The presented approach of close cooperation among different specialties may yield a model by which to establish endovascular treatment possibilities in hospitals without interventional neuroradiologists.”