Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Friday, November 30, 2018

Stroke patients can’t ask for a second opinion: a multi-specialty response to The Joint Commission’s recent suspension of individual stroke surgeon training and volume standards

You'll have to hope your stroke hospital has enforced standards for stroke surgeons. Or you'll have to ask your surgeon for proof of experience and success.

Stroke patients can’t ask for a second opinion: a multi-specialty response to The Joint Commission’s recent suspension of individual stroke surgeon training and volume standards


  1. Adam S Arthur1,
  2. J Mocco2,
  3. Italo Linfante3,
  4. David Fiorella4,
  5. M Shazam Hussain5,
  6. Tudor G Jovin6,
  7. Raul Nogueira7,
  8. Clemens Schirmer8,
  9. John D Barr9,
  10. Phillip M Meyers10,
  11. Reade De Leacy11,
  12. Felipe C Albuquerque12

Author affiliations

Statistics from Altmetric.com


If you were considering surgery on your brain to stave off a devastating stroke, you might ask about the training of the surgeon. You might ask how many times they had done the procedure. Unfortunately, patients with emergent large vessel occlusion strokes (ELVO) often cannot ask these important questions. Even if they could, they lack the time to consider their options. They depend on the healthcare system to bring them to a surgeon who gives them the best chance.
On September 17 2018, The Joint Commission (TJC) announced the suspension of individual physician training and volume requirements for acute ischemic stroke thrombectomy at hospitals certified as Comprehensive Stroke Centers (CSC) and Thrombectomy-Capable Stroke Centers (TCC). TJC decided to remove its previously established requirement for both an individual thrombectomy volume minimum and for physician-specific certification to perform acute stroke thrombectomy. These requirements were established based on multiple discussions of TJC’s own technical advisory panel (TAP). No discussion was held with the TAP before the suspension of training and volume requirements for individual physicians.

Why have individual requirements?

Initial evidence to support these requirements can be found in the multi-specialty recommendations for training by the Committee for Advanced Subspecialty Training (CAST).1 These recommendations emphasize the importance of training and experience for achieving optimal outcomes. As essential elements, the CAST recommendations include: cognitive training in the clinical neurosciences; critical procedural neuroendovascular training; and annual performance of a minimum of thrombectomies and other neuroendovascular procedures. These recommendations are based on a large body of evidence published in peer-reviewed literature consistently demonstrating that standards of training and case volumes for both physician operators and treating medical centers significantly influence procedural outcomes and should be requirements to ensure high-quality care for patients.2–6 The physician volume requirement is further supported by the same 2016 Centers for Medicare and Medicaid Services (CMS) Physician Supplier and Provider Services (PSPS) files and Provider Utilization File (PUF) cited by TJC in their suspension of volume requirement justification. The cited median volume of 15 thrombectomies for the physician cohort with >10 thrombectomies does not take into account that Medicare represented only 59% of thrombectomy patients.7 Simply adjusting for this differential raises the median to 25 thrombectomies. Additionally, the cited data do not account for the 30% increase in CMS thrombectomy claims from 2016 to 2017 (2016=5905 versus 2017=7649). This would suggest the median total volume for those same physicians would approximate to 35 in 2017. While 2018 data are not yet available, it is hard to imagine that these thrombectomy numbers have declined. By suspending physician training and volume requirements, TJC has adopted a position that lacks evidentiary foundation and is detrimental to patients.

Thrombectomy is effective… when performed by high-volume physicians who have undergone advanced subspecialty training

Level 1A evidence gathered from 10 randomized, controlled clinical stroke trials has unequivocally proven thrombectomy superior to medical management for acute ischemic stroke secondary to large vessel occlusion.8–17 It is essential to realize that these studies required experienced neuroendovascular physicians with established neurovascular clinical expertise. Translation of the beneficial outcomes from such trials into community practice without specialized physicians cannot be assumed. The importance of specialty expertise and volume was so important to these trials that, shortly after the trials’ publications, many of the principal Investigators came together in 2015 to write an editorial emphasizing this critical aspect of their studies.18 In this editorial, the authors emphasized, ’These data strongly suggest that high-volume centers that frequently treat stroke patients achieve better outcomes than low-volume hospitals that care for stroke patients infrequently. The recently published trials all enrolled the vast majority of their patients at such centers. As a result, it is reasonable to assume that similar outcomes may not be obtained from lower volume, less specialized hospitals.’ They further state that, ‘neurointerventionalists with appropriate expertise… are… critical components’ to thrombectomy care, and that ‘inexperienced or low-volume stroke hospitals will potentially jeopardize patient care and could lead to worse outcomes.’ These authors, many of whom ran the definitive trials providing evidence for thrombectomy, then concluded, ‘To ensure attainment of trial results in actual practice, patients should receive treatment at facilities certified as having the resources, personnel, organization, and continuous quality improvement processes characteristic of trial centers.’ The concept that low-volume, non-credentialed practitioners can suffice to garner TCC or CSC certification is as unrealistic now as it was in 2015.
The assumption that the benefit of acute stroke thrombectomy performed by expert physicians persists for physicians who lack neuroscience, cognitive, and procedural training, or who are operating with low case volumes is flawed. Furthermore, this assumption is not substantiated by published evidence and, if applied for certification or credentialing purposes, almost certainly will result in substandard patient outcomes.

More at link. 

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