title: Neurothrombectomy trial results: stroke systems, not just devices, make the difference.
abstract: The overwhelming benefit demonstrated in the four recent randomized trials comparing intra-arterial therapies to medical management alone will have a transformative effect on the emergent management of strokes throughout the world. New generation neurothrombectomy devices were critical to trial success, but not the sole driver of patient outcomes in these trials. Patients in the positive trials were treated at hospitals with complex, efficient, resource-rich, team-based stroke systems in place. To ensure attainment of trial results in actual practice, patients should receive treatment at facilities certified as having the resources, personnel, organization, and continuous quality improvement processes characteristic of trial centers. It is our hope that, through greater education initiatives, robust resource investment, and developing quality-based certification processes, the results demonstrated by these trials may be extrapolated to greater numbers of centers - in turn allowing greater access for patients to high-quality, advanced stroke care.
authors.affiliation: Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.affiliation: Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.affiliation: Department of Radiology, University of Calgary, Calgary, AB, Canada.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.affiliation: Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: Department of Radiology, University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mitchell
authors.affiliation: Department of Medicine and Neurology, Melbourne Brain Center at the Royal Melbourne Hospital, Parkville, Victoria, Australia.
authors.forename: Bruce C V
authors.initials: BC
authors.lastname: Campbell
authors.affiliation: Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Charles B L M
authors.initials: CB
authors.lastname: Majoie
authors.affiliation: Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.affiliation: Department of Neurology and Rehabilitation Medicine, University of Cincinnati Neuroscience Institute, Cincinnati, OH, USA.
authors.forename: Pooja
authors.initials: P
authors.lastname: Khatri
authors.affiliation: Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
authors.forename: Michael D
authors.identifier: http://orcid.org/0000-0002-6269-1543
authors.initials: MD
authors.lastname: Hill
authors.affiliation: Comprehensive Stroke Center and Department of Neurology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Saver
mesh_terms: D004864:Equipment and Supplies; D006801:Humans; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000175:diagnosis / Q000628:therapy*; D017131:Thrombectomy / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome
keywords: acute ischemic stroke; stent retriever; stroke systems; thrombectomy