Endovascular Therapy Update
6-24 Hour Treatment Window in Endovascular Therapy
Endovascular Therapy (EVT) for the treatment of ischemic stroke, involves the mechanical removal of a blood clot within a large vessel (artery) of the brain. Treatment within 0-6 hours of stroke symptom onset is a safe and efficacious intervention reducing death and disability for patients that are eligible for this treatment. More recent studies are showing that an additional select group of patients may benefit from this intervention if they present to an EVT site greater than 6 hours and within 24 hours of stroke symptom onset.
CorHealth Ontario hosted a webinar on June 20, 2018, delivered by Dr. Vitor Pereira, Interventional Neuroradiologist/Endovascular Neurosurgeon from UHN, on evidence and potential implications of the 6–24 hour Endovascular Thrombectomy (EVT) Treatment Window for acute ischemic stroke (AIS). To listen to the webinar recording and view the slide deck, please click the links below:
On July 18, 2018 the Heart & Stroke Foundation released an update to the Canadian Stroke Best Practice Recommendations on Acute Stroke Management including statements around endovascular therapy in the 6-24 hour treatment window. Representatives/stakeholders across the province are actively involved in discussions about implications and planning for this emerging evidence and readiness of the system to implement. CorHealth Ontario’s EVT Steering Committee, Co-Chaired by Dr. Grant Stotts and Dr. Timo Krings, will continue to review the implications of the 6-24 Hour Treatment Window in Endovascular Therapy to contribute to any recommendations moving forward.
Endovascular Therapy Centres Complete CIHI Special Project 440
CorHealth Ontario, Heart & Stroke and the Canadian Institute for Health Information (CIHI) came together on a joint effort on a new project called CIHI Special Project 440. The project was launched to develop and implement an ongoing Endovascular Treatment (EVT) performance measurement, monitoring and reporting system that will be used nationally to ensure alignment with best practice, inform system planning and drive quality improvement initiatives.
A provincial EVT Performance Measurement and Monitoring Task Group was established to inform the development of EVT metrics that will allow for a better understanding of:
- EVT patient volumes across the 10 EVT centres
- Current access to EVT at both provincial and regional levels
- Appropriateness of EVT referrals
- Timeliness of EVT diagnostics/intervention
- Outcomes associated with the provision of EVT
Reporting to the Endovascular Therapy Steering Committee, the EVT Performance Measurement and Monitoring Task Group has worked collaboratively with CorHealth Ontario to identify nine indicators and the technical specifications to ensure measurement is accurate and meaningful.
| EVT QUALITY INDICATORS | |
|---|---|
| 1. | *Proportion and number of ischemic stroke patients who received an EVT procedure |
| 2. | Proportion of EVT patients who received CTA, CTP or MRA prior to the EVT procedure |
| 3. | *Proportion of patients transferred to EVT centres who received EVT |
| 4. | Proportion of EVT patients successfully reperfused |
| 5. | *30-day risk-adjusted all-cause mortality rates for patients who received EVT |
| 6. | *Median number of days EVT patients spend at home in the first 90 days post procedure |
| 7. | Median (25th and 75th percentile) time from ED arrival to qualifying CTA, CTP, MRA |
| 8. | Median (25th and 75th percentile) time from ED arrival (at EVT site) to arterial puncture |
| 9. | Median (25th and 75th percentile) time from ED arrival (at EVT site) to time of first reperfusion |
| * Indicators not relying on CIHI - Stroke Special Project 440 | |
Five out of nine indicators will rely on the data captured in the project and the remaining indicators will rely on existing data fields in the standard administrative databases, such as CIHI National Ambulatory Care Reporting System (NACRS), Discharge Abstract Database (DAD) and National Rehabilitation Reporting System (NRS).
CorHealth Ontario will produce a one-time baseline 17/18 EVT indicators retrospective report and an ongoing EVT reporting cycle will be developed to provide sites with biannual and annual reports.