Deans' stroke musings: Effect of Cumulative Case Volume on Procedural and Clinical Outcomes in Endovascular Thrombectomy

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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.

Friday, April 5, 2019

Effect of Cumulative Case Volume on Procedural and Clinical Outcomes in Endovascular Thrombectomy

As a doctor said(Johanna Ospel, MD), the more you do the better you get. So before you get this, ask your doctor how good they are. How many of their patients get 100% recovered? That is the definition of good. Anything less is either fair or poor.

Effect of Cumulative Case Volume on Procedural and Clinical Outcomes in Endovascular Thrombectomy

Originally published4 Apr 2019https://doi.org/10.1161/STROKEAHA.119.024986Stroke. 2019;0

Abstract

Background and Purpose—

The effect of endovascular thrombectomy (EVT) cumulative case volume (EVT-CCV) on outcomes of acute stroke patients has not been studied. This study investigated whether EVT-CCV was associated with outcomes.

Methods—

We identified all patients who underwent EVT for anterior circulation large vessel occlusion. Patients who met enrollment criteria were grouped into 5 based on the number of previous cases at each hospital. The number of cases that were recruited from each hospital and then assigned to each group (n) was designed to increase by the function of 10×2^(n-1); group 1 consisted of cases 1 to 10 at each hospital, group 2 was cases 11 to 30, group 3 was cases 31 to 70, group 4 was cases 71 to 150, and group 5 was cases ≥151. We tested whether EVT-CCV group was associated with procedural and clinical outcomes.

Results—

Nine hundred fifty-five patients fulfilled the enrollment criteria. Recanalization and good outcome positively correlated with EVT-CCV group (P<0.001 [correlation coefficient, r=0.122] for recanalization; P=0.002 [r=0.099] for good outcome), whereas symptomatic intracranial hemorrhage and mortality negatively correlated (P=0.039 [r=–0.067] for symptomatic intracranial hemorrhage; P=0.016 [r=–0.078] for mortality). EVT-CCV group was independently associated with recanalization (odds ratio, 1.182; 95% CI, 1.029–1.358) and good outcome (odds ratio, 1.187; 95% CI, 1.053–1.337).

Conclusions—

With increased EVT-CCV, recanalization and good outcome increased, whereas symptomatic intracranial hemorrhage and mortality decreased. Increased EVT-CCV was independently associated with recanalization and good outcome.

Footnotes

The online-only Data Supplement is available with this article at https://www.ahajournals.org/doi/suppl/10.1161/STROKEAHA.119.024986.

Correspondence to Byung Moon Kim, MD, PhD, Interventional Neuroradiology, Severance Stroke Center, Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 50–1, Seodaemun-gu, Seoul, Republic of Korea 03722. Email bmoon21@yuhs.ac