Except for the fact that your definition of success is completely wrong. 100% RECOVERY IS THE GOAL. WHAT THE HELL ARE YOU DOING TO GET THERE?
Procedure Time Proves Vital in Thrombectomy Success
The
current standard of care for stroke should also factor in procedure
time when considering surgical intervention, according to a study
published in the Journal of the American College of Cardiology.
“[Surgeons] will try once to remove the clot,” said Ali Alawieh, MD, Medical University of South Carolina (MUSC), Charleston, South Carolina. “They’ll then try 2, 3, and even 4 times or more hoping for a successful attempt. The idea of [this study] is to quantify that -- to look for a limit where you start doing more harm than good.”
By studying the number of attempts and the amount of time spent performing procedures, Dr. Alawieh and colleagues concluded that the likelihood of completing an endovascular thrombectomy without significantly increasing the risk for the patient decreases dramatically after the first 30 to 60 minutes, depending on the technique used.
By comparing endovascular thrombectomies performed using either stent retrievers (SR) or aspiration (ADAPT), the researchers found that the most important detail to consider was the time spent manipulating the vessel. Conducting the procedure with an SR means it takes the surgeon longer to get to the vessel than with ADAPT, but the factor that influences patient outcomes is the amount of time needed once the surgical team reaches the clot.
Using SRs, the golden time for the procedure is at the hour mark, and using ADAPT, it is 30 minutes.
“We had noticed this trend at MUSC, but we wanted to know if it extended nationally,” said Dr. Alawieh. “As it turns out, it does. After that 30- to 60-minute mark, depending on the procedure, surgeons should pause and reassess if the procedure is worth continuing.”
Prior studies have shown that extending the duration of mechanical thrombectomies past 60 minutes, and more recently past 35 minutes, decreases the chance a patient will show few or no neurological disabilities after 90 days and increases the chance of a post-procedural haemorrhage. The current study supports those findings at a multicentre national level and shows complication rates increase by the minute and were not dependent on the treatment centre.
“Stroke intervention procedures have improved dramatically in recent years, and they are so effective in helping patients, that it’s difficult for the physician to give up on a procedure when it’s not successful,” said Alejandro M. Spiotta, MD, MUSC. “The major impact of this work is that it provides a potential stopping point for surgeons where the procedure can cause more harm than good.”
Reference: http://dx.doi.org/10.1016/j.jacc.2018.11.052
SOURCE: Medical University of South Carolina
“[Surgeons] will try once to remove the clot,” said Ali Alawieh, MD, Medical University of South Carolina (MUSC), Charleston, South Carolina. “They’ll then try 2, 3, and even 4 times or more hoping for a successful attempt. The idea of [this study] is to quantify that -- to look for a limit where you start doing more harm than good.”
By studying the number of attempts and the amount of time spent performing procedures, Dr. Alawieh and colleagues concluded that the likelihood of completing an endovascular thrombectomy without significantly increasing the risk for the patient decreases dramatically after the first 30 to 60 minutes, depending on the technique used.
By comparing endovascular thrombectomies performed using either stent retrievers (SR) or aspiration (ADAPT), the researchers found that the most important detail to consider was the time spent manipulating the vessel. Conducting the procedure with an SR means it takes the surgeon longer to get to the vessel than with ADAPT, but the factor that influences patient outcomes is the amount of time needed once the surgical team reaches the clot.
Using SRs, the golden time for the procedure is at the hour mark, and using ADAPT, it is 30 minutes.
“We had noticed this trend at MUSC, but we wanted to know if it extended nationally,” said Dr. Alawieh. “As it turns out, it does. After that 30- to 60-minute mark, depending on the procedure, surgeons should pause and reassess if the procedure is worth continuing.”
Prior studies have shown that extending the duration of mechanical thrombectomies past 60 minutes, and more recently past 35 minutes, decreases the chance a patient will show few or no neurological disabilities after 90 days and increases the chance of a post-procedural haemorrhage. The current study supports those findings at a multicentre national level and shows complication rates increase by the minute and were not dependent on the treatment centre.
“Stroke intervention procedures have improved dramatically in recent years, and they are so effective in helping patients, that it’s difficult for the physician to give up on a procedure when it’s not successful,” said Alejandro M. Spiotta, MD, MUSC. “The major impact of this work is that it provides a potential stopping point for surgeons where the procedure can cause more harm than good.”
Reference: http://dx.doi.org/10.1016/j.jacc.2018.11.052
SOURCE: Medical University of South Carolina
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