STRATIS Registry Evaluates Efficiency in Stroke Treatment; SNIS Aims to "Get Ahead of Stroke"

July 27, 2016—Findings from the STRATIS registry presented at the Society of NeuroInterventional Surgery's (SNIS) 13th Annual Meeting in Boston, Massachusetts, found that stroke patients who go directly to an endovascular center could potentially receive treatment 99 minutes earlier.

The STRATIS registry evaluated systems-of-care efficiency and interhospital transfer delays. Investigators assessed the real-world delivery to care, specific causes of treatment delays, and time lost because of interhospital transfers. The investigators also calculated a hypothetical “bypass” scenario wherein stroke patients were taken directly to an endovascular center instead of the nearest hospital. The study was presented by lead investigator Michael Froehler, MD, Director of the Cerebrovascular Program at Vanderbilt University Medical Center in Nashville, Tennessee.

The STRATIS investigators found that for patients who received intravenous tissue plasminogen activator treatment before undergoing endovascular treatment, median alarm-to-treatment times between direct patients versus transfer patients were 169 and 268 minutes, respectively. In the SNIS announcement, Dr. Froehler commented, “Our study found that treatment is delayed by about an hour and a half if patients must be transferred from one hospital to another. Based on earlier studies, that means that the chance of a good outcome for those patients is reduced by 30% to 40%.” Dr. Froehler noted that the results also suggest that in some circumstances, patients might be better off taking a longer drive to a hospital if it means arriving at a neurointerventional-ready facility. Patient-level analyses of actual routes taken are ongoing. 

SNIS President Donald Frei, MD, added, “We are committed to improving patient outcomes and organizing more effective systems of care across the country. This study shows us we have to improve our processes for getting patients to the right center directly. We need to implement this valuable insight so we can give patients the timely response they deserve for the best possible outcomes.”

In May, the SNIS announced the launch of the Get Ahead of Stroke campaign, which is focused on organizing stronger stroke systems of care nationwide, based on critical observations of studies similar to the STRATIS registry. The SNIS describes the campaign as a grassroots legislative initiative to standardize protocols for these patients across the diverse local, county, and state health care systems in the United States, which vary considerably. The multiyear initiative seeks to enact legislative change in all 50 states, requiring emergency medical services (EMS) to take ischemic stroke/large vessel occlusion (LVO) patients to neurointerventional-ready hospitals.

Speaking with Endovascular Today at the 2016 SNIS meeting, Dr. Frei described the program's goal as being analogous to current trauma systems of care, wherein patients are taken by EMS to a designated trauma center as standard protocol. In contrast, he said, many EMS do not currently have the triage tools to identify LVO, nor specific guidelines or protocols as to the ideal facility to which to bring the LVO patient.

"EMS brings the patient to the closest hospital, and more likely than not, that hospital can’t do a thrombectomy, and they have to be transported to the next hospital that can. It’s a waste of 1 to 2 hours, [during which] the chance of a good outcome drops," said Dr. Frei. "The best case scenario is that someone calls 9-1-1, the EMS arrives and identifies the LVO in the field, and brings the patient to an endovascular-capable hospital."  

Whereas much of the focus at the 2015 SNIS meeting focused on the emergence of thrombectomy as a standard of care in LVO therapy, "The theme of this year’s meeting is much more toward ‘systems of care,’ ” said William J. Mack, MD, Assistant Professor of Neurological Surgery at Keck Medicine at the University of Southern California and Co-Chair of the SNIS 13th Annual Meeting. Now that an effective means of opening the vessel has been identified, he said, the stroke-related research presented this year in Boston largely focused on identifying those patients who will most benefit from available therapies, and how to deliver more efficient care. Key sessions included reducing door-to-needle times, identifying and disseminating successful program elements, and eliminating delays in the care timeline for these patients. 

More information is available online at www.getaheadofstroke.org.