• Eur. J. Neurol. · Feb 2016

    A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience.

    • M Alonso de Leciñana, B Fuentes, Á Ximénez-Carrillo, J Vivancos, J Masjuan, A Gil-Nuñez, P Martínez-Sánchez, G Zapata-Wainberg, A Cruz-Culebras, A García-Pastor, F Díaz-Otero, E Fandiño, R Frutos, J-L Caniego, J-C Méndez, A Fernández-Prieto, E Bárcena-Ruiz, E Díez-Tejedor, and Madrid Stroke Network.
    • Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
    • Eur. J. Neurol. 2016 Feb 1; 23 (2): 297-303.

    Background And PurposeThe complexity and expense of endovascular treatment (EVT) for acute ischaemic stroke (AIS) can present difficulties in bringing this approach closer to the patients. A collaborative node was implemented involving three stroke centres (SCs) within the Madrid Stroke Network to provide round-the-clock access to EVT for AIS.MethodsA weekly schedule was established to ensure that at least one SC was 'on-call' to provide EVT for all those with moderate to severe AIS due to large vessel occlusion, >4.5 h from symptom onset, or within this time-window but with contraindication to, or failure of, systemic thrombolysis. The time-window for treatment was 8 h for anterior circulation stroke and <24 h in posterior stroke. Outcomes measured were re-canalization rates, modified Rankin Scale (mRS) score at 3 months, mortality and symptomatic intra-cranial haemorrhage (SICH).ResultsOver a 2-year period (2012-2013), 303 candidate patients with AIS were considered for EVT as per protocol, and 196 (65%) received treatment. Reasons for non-treatment were significant improvement (14%), spontaneous re-canalization (26%), clinical worsening (9%) or radiological criteria of established infarction (31%). Re-canalization rate amongst treated patients was 80%. Median delay from symptom onset to re-canalization was 323 min (p25; p75 percentiles 255; 430). Mortality was 11%; independence (mRS 0-2) was 58%; SICH was 3%.ConclusionsImplementation of a collaborative network to provide EVT for AIS is feasible and effective. Results are good in terms of re-canalization rates and clinical outcomes.© 2015 EAN.

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