Hospital Buyer

An effort spearheaded by the Society for Cardiovascular Angiography and Interventions (SCAI) is calling for increased use of catheter-based approaches to treat patients who have had a stroke. In particular, the group suggests expanding the number of physicians who could safely, effectively perform these procedures and to expand programs to treat stroke victims rapidly. This effort was described in the journal Catheterization and Cardiovascular Interventions (CCI).

Endovascular stroke therapy, or catheter-based treatment, is an attractive option to manage patients with stroke. The standard treatment for stroke is clot-busting therapy. This treatment, however, is limited because it is only effective when delivered within three hours of the stroke symptoms commencing. Estimates suggest that this therapy is used in only two percent of patients who present with stroke.

Endovascular approaches, alternatively, can be used to manage stroke patients within six to eight hours of stroke symptoms. The treatment entails threading a catheter from a groan artery, through the aorta and carotid arteries, and up to the artery in the brain where the clot causing the stroke is located. With that means to access the clot, it can be removed and a stent placed in the brain to restore blood flow. An alternative to such is using the catheter as a means to directly target clot-busting therapy on the surface of the clot.

This procedure is most often completed by interventional neuroradiologists, of which there are few nationally. According to a report on Medical News Today, five states do not have any such physicians to complete this procedure. The document prepared by SCAI describes expanding the cohort of physicians available with appropriate training to complete these.

The skill sets of interventional radiologists, vascular surgeons, and interventional cardiologists who perform neuro-rescue are akin to those required for endovascular stroke therapy. This may make these physicians the ideal clinicians with the experience to take on this responsibility. The Society calls for the development of stroke teams, just as centers developed heart teams to respond to heart attack victims and reduce “Door to Balloon” times. Efforts for that disease were previously described on Hospital Buyer.

This modification may alter the operation of emergency rooms as they treat stroke victims. As well, a change in guidelines to use catheter-based approaches rather than clot busting drugs would impact procurement and work flow in healthcare facilities. Whether the clinical guidelines to treat this condition are modified will further inform these two areas.

August 27, 2007 Related topics: Cardiology, Materials Management