A Comprehensive Nationwide Evaluation of Stroke Centres in the Czech Republic Performing Mechanical Thrombectomy in Acute Stroke in 2016


Authors: O. Volný 1,2;  M. Bar 3,4;  A. Krajina 5;  P. Cimflová 2,6;  L. Kašičková 4;  R. Herzig 7;  D. Šaňák 8;  O. Škoda 9,10;  A. Tomek 11;  D. Školoudík 12;  D. Václavík 13;  J. Neumann 14;  M. Köcher 15;  M. Roček 16;  R. Pádr 16;  F. Cihlář 17;  R. Mikulík 1,2
Authors‘ workplace: 1. neurologická klinika LF MU a FN u sv. Anny v Brně 1;  ICRC – Mezinárodní centrum klinického výzkumu, FN u sv. Anny v Brně 2;  Komplexní cerebrovaskulární centrum FN Ostrava 3;  Katedra neurologie a psychiatrie LF OU v Ostravě 4;  Radiologická klinika LF UK a FN Hradec Králové 5;  Klinika zobrazovacích metod LF MU a FN u sv. Anny v Brně 6;  Komplexní cerebrovaskulární centrum Neurologická klinika LF UK a FN Hradec Králové 7;  Komplexní cerebrovaskulární centrum Neurologická klinika LF UP a FN Olomouc 8;  Neurologická klinika 3. LF UK a FN Královské Vinohrady, Praha 9;  Neurologické oddělení Nemocnice Jihlava 10;  Neurologická klinika 2. LF UK a FN Motol, Praha 11;  Centrum vědy a výzkumu FZV UP v Olomouci 12;  Neurologické oddělení Vítkovická nemocnice a. s., Ostrava 13;  Neurologické oddělení, Krajská zdravotní a. s., Nemocnice Chomutov, o. z. 14;  Radiologická klinika LF UP a FN Olomouc 15;  Klinika zobrazovacích metod 2. LF UK a FN Motol, Praha 16;  Oddělení radiologie, Krajská zdravotní a. s., Masarykova nemocnice v Ústí nad Labem, o. z. 17
Published in: Cesk Slov Neurol N 2017; 80/113(4): 445-450
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2017445

Overview

Introduction:
Mechanical thrombectomy (MT) has been established as a standard of care in acute ischaemic stroke. We systematically evaluated all stroke centres conducting MT in the Czech Republic.

Methods:
An online questionnaire based on the International Multi-Society Consensus Document was distributed to all such centres to monitor all the procedures in 2016. It includes 64 questions on imaging, logistic and training standards related to MT.

Results:
Complete data were obtained from all 15 comprehensive stroke centres. Local operating procedures are used in 14 centres. Specialised stroke units are available in all centres, 24/7 CT is available in all centres and 24/7 MRI in 11 centres. Admission imaging in a time window < 6 hours includes: CT/CTA in 11, CT/CTA/CTP in 6, MRI/MRA in 2 centres; after 6 hours from the symptoms: CT/CTA is performed in 7, CT/CTA/CTP in 14, MRI/MRA in 5 centres. Early ischaemic changes are evaluated before neuro-intervention in all centres and collaterals are scored in 8 centres. Interventionalists are available 24/7 in all centres. Door-to-groin time < 60 min is monitored in 14 and door-to-reperfusion < 90 min in 10 centres. Analgosedation is preferred over general anaesthesia in all centres. Fourteen centres enter data into a registry (SITS-TBY). 1,053 MTs (range: 17–136/centre) were performed in 2016. There are 49 neuro-interventional trainees and 64 interventionalists providing MT in 2016.

Conclusion:
The Czech Republic has a high availability of expertise to perform MT in acute ischaemic stroke. Nevertheless, there is a high variability among the centers. Thus, the next step should be regular quality monitoring and evaluation of patients’ data.

Key words:
mechanical thrombectomy – acute stroke – questionnaire – nationwide evaluation

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.


Chinese summary - 摘要

2016年捷克共和国脑卒中中心急性卒中机械性血栓切除术综合评估

介绍:

机械性血栓切除术(MT)已被确定为急性缺血性卒中的标准治疗方式。我们对捷克共和国所有脑卒中中心进行的MT进行了综合评估。我们系统地评估了所有在捷克共和国进行MT治疗的卒中中心。

方法:

根据“国际多社会共识文件”向所有这些中心分发的一份在线调查表,以监测2016年的所有程序。其中包括64个与MT有关的成像、逻辑和培训标准的问题。

结果:

所有数据来自15个综合脑卒中中心,其中14个中心使用当地操作程序。所有中心都有专门的脑卒中单位,所有中心均提供24/7 CT,11个中心提供24/7 MRI。允许的6小时以内的时窗成像包括:11个中心的CT/CTA、6个中心的CT/CTA/CTP和2个中心的MRI/MRA;症状发生6小时后:7个中心的CT/CTA、14个中心的CT/CTA/CTP和5个中心的MRI/MRA。所有中心在神经干预之前进行早期缺血性改变评估,并在8个中心进行评分。所有中心24/7可介入。在14中心监测腹壁至腹股沟时间<60分钟,并在10个中心监测腹壁至再灌注<90分钟。所有中心认为进行止痛镇静比进行全身麻醉好,14个中心将数据传入登记处(SITS-TBY)。2016年共执行1,053个MT(范围:17-136个/中心),共有49个神经介入实习生和64个介入医师提供MT。

结论:

捷克共和国在急性缺血性卒中方面有很高的专业性来进行MT。尽管如此,这些中心之间的差异也很大。 因此,下一步应定期对患者数据进行质量监测和评估。

关键词:

机械性血栓切除术 - 急性脑卒中 - 问卷调查 - 全国性评估


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Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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