title: [Endovascular treatment in acute ischaemic stroke. A stroke care plan for the region of Madrid].
abstract: BACKGROUND
  Endovascular therapies (intra-arterial thrombolysis and mechanical thrombectomy) after acute ischaemic stroke are being implemented in the clinical setting even as they are still being researched. Since we lack sufficient data to establish accurate evidence-based recommendations for use of these treatments, we must develop clinical protocols based on current knowledge and carefully monitor all procedures.
  
  
  METHODS
  After review of the literature and holding work sessions to reach a consensus among experts, we developed a clinical protocol including indications and contraindications for endovascular therapies use in acute ischaemic stroke. The protocol includes methodology recommendations for diagnosing and selecting patients, performing revascularisation procedures, and for subsequent patient management. Its objective is to increase the likelihood of efficacy and treatment benefit and minimise risk of complications and ineffective recanalisation. Based on an analysis of healthcare needs and available resources, a cooperative inter-hospital care system has been developed. This helps to ensure availability of endovascular therapies to all patients, a fast response time, and a good cost-to-efficacy ratio. It includes also a prospective register which serves to monitor procedures in order to identify any opportunities for improvement.
  
  
  CONCLUSIONS
  Implementation of endovascular techniques for treating acute ischaemic stroke requires the elaboration of evidence-based clinical protocols and the establishment of appropriate cooperative healthcare networks guaranteeing both the availability and the quality of these actions. Such procedures must be monitored in order to improve methodology.
authors.forename: M
authors.initials: M
authors.lastname: Alonso de Leciñana
authors.forename: J
authors.initials: J
authors.lastname: Díaz-Guzmán
authors.forename: J A
authors.initials: JA
authors.lastname: Egido
authors.forename: A
authors.initials: A
authors.lastname: García Pastor
authors.forename: P
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.forename: J
authors.initials: J
authors.lastname: Vivancos
authors.forename: E
authors.initials: E
authors.lastname: Díez-Tejedor
mesh_terms: D002545:Brain Ischemia / Q000601:surgery*; D032921:Consensus; D000075202:Contraindications; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D013030:Spain; D020521:Stroke / Q000601:surgery*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
keywords: Activador tisular del plasminógeno recombinante; Endovascular treatment; Ictus isquémico; Ischaemic stroke; Mechanical thrombectomy; Neurointervencionismo; Neurointerventional surgery; Thrombolysis; Tratamiento endovascular; Trombectomía; Trombólisis; rtPA