The Society for Vascular and Interventional Neurology (SVIN) has developed Stroke Interventional Laboratory Consensus (SILC) criteria to standardise stroke interventional laboratories for safe, effective, and timely stroke care worldwide.
“Brain attack care is now exploding with new devices and options, just as heart attack care grew rapidly in the 1990s,” says Tanzila Shams, and lead author of a report on the criteria published Interventional Neurology. “There is an unmet need to establish a new national standard to provide optimal, timely stroke care to all patients suffering from acute ischaemic strokes.”
The SILC criteria reflect the need to clearly distinguish stroke interventional lab capabilities at a time of rapid advancements in stroke treatment, including the use of stent retrieval devices, vacuum suction devices, and clot-busting drugs to save lives and reduce long-term damage to the brain. “Our hope is that these consensus criteria will provide the roadmap for growth of high quality stroke intervention labs worldwide similar to the growth of cardiac catheterization labs,” says SVIN past-president Tudor Jovin, co-author of the report.
To advance this goal, SVIN developed a “7M” management approach for standardising stroke infrastructure and includes:
- Manpower: personnel including roles of medical and administrative directors, interventional technologists, interventional nurses, physician extenders, and all the key stakeholders in the stroke chain of survival;
- Machines: resources needed in terms of physical facilities, and angiography equipment;
- Materials: medical device inventory, medications, and angiography supplies;
- Methods: standardised protocols for stroke workflow optimization;
- Metrics (volume): existing credentialing criteria for facilities and stroke interventionalists;
- Metrics (quality): benchmarks for quality assurance; and
- Metrics (safety): radiation and procedural safety practices;
“National efforts in the uniform organisation, accreditation, and certification of stroke intervention practices are more important than ever,” says Vallabh Janardhan, and senior author of the report. “For effective stroke therapy to reach millions of people, we need to have the right infrastructure in place.”
Several societies and organisations, including the National Institute of Neurological Disorders and Stroke (NINDS) Brain Attack Coalition, American Heart Association/ American Stroke Association (AHA/ASA), and stroke centre certifying bodies including The Joint Commission, Det Norske Veritas (DNV) Healthcare, and Hospital Facilities Accreditation Program (HFAP) endorse the systematic organisation of stroke care operations at a national level.
In the past year, a series of studies have demonstrated the benefit of catheter-based interventions for treating stroke patients with large vessel occlusions. These studies have shown that using stent retrieval devices by themselves or with vacuum aspirators or clot-busting medications are highly effective in removing blockages and restoring blood circulation to the brain, even very severe strokes. “Standardising stroke interventional labs will increase treatment rates and help achieve SVIN’s Mission 2020 goal of 200,000 clot retrieval procedures worldwide by the year 2020,” says Dileep Yavagal, SVIN past-president, and co-author of the report.
“We now have exciting new therapies for brain attacks, such as retrievable stents and vacuum suction devices that are similar to balloons and stents for heart attacks,” says Janardhan. “But these technology innovations need to be supported by the appropriate stroke interventional lab infrastructure so that patients receive timely care.”
Currently, there are 1,476 primary stroke centres in the USA that can provide clot-busting medications, and more than 170 comprehensive stroke centres whose capabilities include neurosurgical and catheter interventional treatments as well as medications.
“Although this tiered system of stroke centres has improved outcomes in the treatment of strokes, more emphasis is needed on the development and operations of the stroke intervention lab within a stroke centre,” says Janardhan. For instance, standardisation is needed on emergency triage procedures for stroke patients, stroke interventional protocols and equipping, staffing and managing a stroke interventional lab.
“As we enter a new era of stroke care, national standards are needed to direct patients, families and EMS to the right centre,” said Raul Nogueira, SVIN president. “We believe SVIN’s report on consensus criteria can provide a framework for developing those standards, leading to a higher level of care and better patient outcomes.”