title: Endovascular clot retrieval therapy: implications for the organization of stroke systems of care in North America.
abstract: Endovascular acute ischemic stroke therapy is now proven by randomized controlled trials to produce large, clinically meaningful benefits. In response, stroke systems of care must change to increase timely and equitable access to this therapy. In this review, we provide a North American perspective on implications for stroke systems, focusing on the United States and Canada, accompanied by initial recommendations for changes. Most urgently, every community must create access to a hospital that can safely and quickly provide intravenous tissue-type plasminogen activator and immediately transfer appropriate patients onward to a more capable center as required. Safe and effective therapy in the community setting will be ensured by certification programs, performance measurement, and data entry into registries.
authors.affiliation: From the Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.). eesmith@ucalgary.ca.
authors.forename: Eric E
authors.initials: EE
authors.lastname: Smith
authors.affiliation: From the Department of Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (E.E.S.); and Stroke Service, Department of Neurology, Massachusetts General Hospital, Boston (L.H.S.).
authors.forename: Lee H
authors.initials: LH
authors.lastname: Schwamm
mesh_terms: D002170:Canada; D057510:Endovascular Procedures / Q000379:methods*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006782:Hospitals, Special / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014481:United States
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: quality improvement; stroke