title: Does modern ischemic stroke therapy in a large community-based dedicated stroke center improve clinical outcomes? A two-year retrospective study.
abstract: BACKGROUND
  To compare modern endovascular therapies in the acute ischemic stroke patients leading to more comprehensive acute stroke algorithm.
  
  
  METHODS
  A 2-year retrospective nonrandomized study on 76 patients who were placed into 5 different treatment groups for acute ischemic stroke. These groups included: group 1 (no treatment) (n = 24), group 2 (intravenous tissue plasminogen activator [tPA] only) (n = 18), group 3 (intra-arterial [IA] tPA) (n = 9), group 4 (Mechanical Embolus Removal in Cerebral Ischemia [MERCI]; retrieval only) (n = 17), and group 5 (combined IA/MERCI) (n = 8). Age range for all groups was 29-92 years. There were 39 women (51.3%) and 37 men (48.7%). The mean age for all patients was 70.1 years. The pre- and post-National Institutes of Health Stroke Scale (NIHSS) values were obtained for each group on arrival and discharge from the hospital. The results of the 4 treatment cohorts were compared with the no treatment group, providing the relative efficacy of these procedures compared with conservative medical therapy alone.
  
  
  RESULTS
  Group 1 presented with an admission NIHSS value of 11.1 and 8.9 on discharge from the hospital. There was a NIHSS reduction of 2.2 without treatment. Group 2 had an admission NIHSS value of 11.8 and a discharge value of 4.7, resulting in an NIHSS reduction of 7.1. Group 3 had an admission NIHSS value of 16.1 and 7.4 at discharge, resulting in an NIHSS reduction of 8.7. Group 4 had an admission NIHSS value of 15.9 and discharge NIHSS value of 3.1, with an NIHSS reduction of 12.8. Group 5 had an admission NIHSS score of 15.7 and 10.6 at discharge, with an NIHSS reduction of 5.1. Four patients expired during their admission, 2 from group 1 (control group) and 2 from group 5 (combined IA/MERCI group). There was a statistically significant difference for the 5 groups at the P < .05 level in change in NIHSS scores: F (4, 24) = 9.10, P = .000.
  
  
  CONCLUSIONS
  Modern endovascular therapies for acute ischemic stroke do improve clinical outcomes when implemented in the setting of a dedicated comprehensive stroke team.
authors.affiliation: Department of Neurointerventional Radiology and Neuroscience Center, St. Joseph's Hospital and Medical Center, Tampa, Florida. Electronic address: mberlet@tampabay.rr.com.
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Berlet
authors.affiliation: Department of Neurointerventional Radiology and Neuroscience Center, St. Joseph's Hospital and Medical Center, Tampa, Florida.
authors.forename: Glenn W
authors.initials: GW
authors.lastname: Stambo
authors.affiliation: Department of Neurointerventional Radiology and Neuroscience Center, St. Joseph's Hospital and Medical Center, Tampa, Florida.
authors.forename: Merle
authors.initials: M
authors.lastname: Kelley
authors.affiliation: Department of Neurointerventional Radiology and Neuroscience Center, St. Joseph's Hospital and Medical Center, Tampa, Florida.
authors.forename: Kelly
authors.initials: K
authors.lastname: Van Epps
authors.affiliation: Department of Neurointerventional Radiology and Neuroscience Center, St. Joseph's Hospital and Medical Center, Tampa, Florida.
authors.forename: Troy
authors.initials: T
authors.lastname: Woeste
authors.affiliation: Department of Neurointerventional Radiology and Neuroscience Center, St. Joseph's Hospital and Medical Center, Tampa, Florida.
authors.forename: Diana
authors.initials: D
authors.lastname: Steffen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002545:Brain Ischemia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D003153:Community Health Services; D019091:Critical Pathways; D004185:Disability Evaluation; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D017052:Hospital Mortality; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: CT perfusion; MERCI; NIHSS; penumbra; tPA