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Update: We Now Have Certification as a Comprehensive Stroke Center

Today we are bringing you an encore post in light of some really great news: New York Presbyterian Hospital has been awarded certification as a Comprehensive Stroke Center. Enjoy.

Incorporating the Best Evidence in Endovascular Treatment for Stroke Care

Endovascular treatment is used to remove stroke-causing clots.

A stroke is most often the result of a blood clot that prevents blood flow to certain portions of the brain. In much the same way a heart attack can cause the death of heart tissue, a stroke can cause the death of brain tissue in the affected area resulting in disability or even death.

The more quickly a patient can be evaluated and receive the appropriate treatment, the more likely it is that long-term disability can be avoided or minimized. A facility that can quickly diagnose and provide the right treatment, then, is critical for patients suffering a stroke.

In 2012, The Joint Commission, the main organization that accredits healthcare organizations, began offering a new level of certification for those centers that meet the highest level of stroke care–The Comprehensive Stroke Center.

These centers offer close coordination with emergency services, neurointensive care facilities, increased availability of neurosurgical and other neurology related specialties, and a wide array of interventional techniques for stroke patients. 

Over the past year, the importance of this last point–a wider array of interventional techniques–has become evident. Several research trials were published during this time, demonstrating the benefit of endovascular treatment.  Their titles and brief descriptions are listed below:

MR CLEANMulticenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands
This study showed that patients who had a procedure known as “clot retrieval” after clot-disolving drugs had better outcomes than those who received the drugs alone. In a clot retrieval procedure, an instrument is introduced through a vascular system (endovascularly) to grasp the clot and remove it from the artery it is blocking.

ESCAPEEndovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion with Emphasis on Minimizing CT to Recanalization Times
In this trial, patients who received endovascular treatment did significantly better than those who received clot-dissolving drugs alone. The study was stopped because the benefit was so clear during a mid-study analysis.

EXTEND-IAExtending the Time for Thrombolysis in Emergency Neurological Deficits – Intra-Arterial Trial
Patients who received clot-dissolving drugs and endovascular clot removal did better than those who received the drugs alone.

SWIFT PRIME – Stent-Retriever Thrombectomy after Intravenous t-PA vs. t-PA Alone in Stroke
Another study that compared clot-retrieval and clot-dissolving drugs to the drugs alone. Again, the benefits of clot-retrieval were so clear the study was stopped early.

These clear and impressive results highlight a couple of the key components of a Comprehensive Stroke Center–availability of these endovascular therapies and around-the-clock availability of a neurointerventionalist (a physician trained in these endovascular procedures).

Philip M. Meyers, MD, is the Clinical Co-director of Neuroendovascular Services at Columbia University Medical Center/NewYork-Presbyterian Hospital. Dr. Meyers emphasizes that not every stroke patient requires endovascular treatment. “It’s only a very specific group, according to these studies, which is just a fraction of the stroke population.” Dr. Meyers coauthored the recently published analysis of this research that demonstrates that the availability of these treatments can change the outcome for that group of patients significantly.

The Endovascular Center at Columbia University Medical Center/NewYork-Presbyterian Hospital is one of the pioneering institutions in endovascular treatment, offering these treatments locally, and training many of the providers who offer these treatments nationwide. In fact, Dr. Meyers helped author the standards for stroke intervention for the Society of NeuroInterventional Surgery. This organization brings together surgeons, neurologists and neuroradiologists who perform stroke treatment and set the standards of practice.

Patients who suffer stroke should feel confident that they are receiving treatment based on the best and most current research at Columbia University Medical Center/NewYork-Presbyterian Hospital. Even as the hospital prepares its application for approval by The Joint Commission as a Comprehensive Stroke Center, stroke treatment here is literally directed by those who establish the guidelines for stroke treatment nationwide.

For more information about Dr. Philip M. Meyers, MD, visit his bio page here.

Photo Credit: By National Heart Lung and Blood Institute (NIH) (National Heart Lung and Blood Institute (NIH)) [Public domain], via Wikimedia Commons

This post was originally published under the title, Incorporating the Best Evidence in Endovascular Treatment for Stroke Care, on Aug 5, 2015. You can learn more about the hospital’s new certification in this press release here.

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