title: A collaborative system for endovascular treatment of acute ischaemic stroke: the Madrid Stroke Network experience.
abstract: OBJECTIVE
  The complexity and expense of endovascular treatment (EVT) for acute ischaemic stroke (AIS) can present difficulties in bringing this approach closer to the patients. A collaborative node was implemented involving three stroke centres (SCs) within the Madrid Stroke Network to provide round-the-clock access to EVT for AIS.
  
  
  METHODS
  A weekly schedule was established to ensure that at least one SC was 'on-call' to provide EVT for all those with moderate to severe AIS due to large vessel occlusion, >4.5 h from symptom onset, or within this time-window but with contraindication to, or failure of, systemic thrombolysis. The time-window for treatment was 8 h for anterior circulation stroke and <24 h in posterior stroke. Outcomes measured were re-canalization rates, modified Rankin Scale (mRS) score at 3 months, mortality and symptomatic intra-cranial haemorrhage (SICH).
  
  
  RESULTS
  Over a 2-year period (2012-2013), 303 candidate patients with AIS were considered for EVT as per protocol, and 196 (65%) received treatment. Reasons for non-treatment were significant improvement (14%), spontaneous re-canalization (26%), clinical worsening (9%) or radiological criteria of established infarction (31%). Re-canalization rate amongst treated patients was 80%. Median delay from symptom onset to re-canalization was 323 min (p25; p75 percentiles 255; 430). Mortality was 11%; independence (mRS 0-2) was 58%; SICH was 3%.
  
  
  CONCLUSIONS
  Implementation of a collaborative network to provide EVT for AIS is feasible and effective. Results are good in terms of re-canalization rates and clinical outcomes.
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Alonso de Leciñana
authors.affiliation: Hospital Universitario La Paz IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Fuentes
authors.affiliation: Hospital Universitario La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: Á
authors.initials: Á
authors.lastname: Ximénez-Carrillo
authors.affiliation: Hospital Universitario La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Vivancos
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Masjuan
authors.affiliation: Hospital Universitario Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Gil-Nuñez
authors.affiliation: Hospital Universitario La Paz IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.affiliation: Hospital Universitario La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Zapata-Wainberg
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Cruz-Culebras
authors.affiliation: Hospital Universitario Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: García-Pastor
authors.affiliation: Hospital Universitario Gregorio Marañón, IiSGM, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Díaz-Otero
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Fandiño
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Frutos
authors.affiliation: Hospital Universitario La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: J-L
authors.initials: JL
authors.lastname: Caniego
authors.affiliation: Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain.
authors.forename: J-C
authors.initials: JC
authors.lastname: Méndez
authors.affiliation: Hospital Universitario La Paz IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Fernández-Prieto
authors.affiliation: Hospital Universitario La Princesa, IIS Princesa, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Bárcena-Ruiz
authors.affiliation: Hospital Universitario La Paz IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Díez-Tejedor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000628:therapy*; D002648:Child; D003299:Cooperative Behavior; D019468:Disease Management; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006782:Hospitals, Special / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D013030:Spain; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods; D055815:Young Adult
keywords: endovascular treatment; ischaemic stroke; organized stroke care; stroke management