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A Comprehensive Nationwide Evaluation of Stroke Centres in the Czech Republic Performing Mechanical Thrombectomy in Acute Stroke in 2016

Publication at Second Faculty of Medicine, Third Faculty of Medicine, Faculty of Medicine in Hradec Králové |
2017

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.