A Comprehensive Nationwide Evaluation of Stroke Centres in the Czech Republic Performing Mechanical Thrombectomy in Acute Stroke in 2016
Abstract
Introduction: Mechanical thrombectomy (MT) has been established as a standard of care in acute ischaemic stroke. We systematically evaluated all stroke centres conducting MT in the Czech Republic.
Methods: An online questionnaire based on the International Multi-Society Consensus Document was distributed to all such centres to monitor all the procedures in 2016. It includes 64 questions on imaging, logistic and training standards related to MT.
Results: Complete data were obtained from all 15 comprehensive stroke centres. Local operating procedures are used in 14 centres.
Specialised stroke units are available in all centres, 24/7 CT is available in all centres and 24/7 MRI in 11 centres. Admission imaging in a time window <6 hours includes: CT/CTA in 11, CT/CTA/CTP in 6, MRI/MRA in 2 centres; after 6 hours from the symptoms: CT/CTA is performed in 7, CT/CTA/CTP in 14, MRI/MRA in 5 centres.
Early ischaemic changes are evaluated before neuro-intervention in all centres and collaterals are scored in 8 centres. Interventionalists are available 24/7 in all centres.
Door-to-groin time <60 min is monitored in 14 and door-to-reperfusion <90 min in 10 centres. Analgosedation is preferred over general anaesthesia in all centres.
Fourteen centres enter data into a registry (SITS-TBY). 1,053 MTs (range: 17-136/centre) were performed in 2016. There are 49 neuro-interventional trainees and 64 interventionalists providing MT in 2016.
Conclusion: The Czech Republic has a high availability of expertise to perform MT in acute ischaemic stroke. Nevertheless, there is a high variability among the centers.
Thus, the next step should be regular quality monitoring and evaluation of patients' data.