Thirteen neurointerventional societies set guidelines for centers providing acute ischemic stroke interventions, including volume thresholds.
Level 1 centers should offer the entire range of acute ischemic stroke interventions, including neuroendovascular stroke surgery, and should treat at least 250 patients with stroke per year and should perform at least 50 thrombectomies per year.
Patients with acute ischemic stroke with large-vessel occlusion “should be taken to level 1 stroke centers,” Adam Arthur, MD, MPH, FACS, president of the Society of NeuroInterventional Surgery and a neurointerventionalist at the Semmes-Murphey Clinic in Memphis, Tennessee, said in a press release. “Establishing guidelines at level 2 stroke centers gives patients a chance at the best possible outcome in underserved regions.”
According to the guidelines, level 2 stroke centers should treat at least 100 patients with stroke per year and perform at least 50 thrombectomies per year, with each neurointerventionalist in the center performing at least 15 acute intracranial thrombectomies per year. Given that minimum volume criteria may be difficult to meet initially, level 2 centers may operate below the minimum if they expect to meet the criteria within 12 to 24 months, the authors wrote.
Level 3 stroke centers do not need to offer thrombectomy but should offer IV tissue plasminogen activator and treat at least 50 patients with stroke per year, according to the guidelines.
A dedicated neuro-ICU and on-site open neurological services are required for level 1 centers, optional for level 2 centers and not needed for level 3 centers.
Level 2 centers should be more than 2 hours from any level 1 center and should receive transfers from nearby level 3 centers if there is not a level 1 center within 2 hours of the level 3 center, according to the authors.
The document outlines the following for a level 2 center: Which facilities must be available on-site, what capabilities the angiography suite must have, which personnel and operational procedures are required, how quality improvement processes should be conducted and how community and emergency medical services outreach should be performed.
“These guidelines, issued by this eminent group of organizations, will help facilities around the world maintain the highest standard of care for stroke patients,” Arthur said in the release. – by Erik Swain
Disclosures: The authors report no relevant financial disclosures. Arthur reports he is a consultant for Codman, Medtronic, MicroVention, Penumbra, Sequent, Siemens and Stryker, and has received research support from Sequent and Siemens.