title: The impact of evidence: evolving therapy for acute ischemic stroke in a large healthcare system.
abstract: BACKGROUND
  With a recent surge of clinical trials, the treatment of ischemic stroke has undergone dramatic changes.
  
  
  OBJECTIVE
  To evaluate the impact of evidence and a revamped stroke protocol on a large healthcare system.
  
  
  METHODS
  A retrospective review of 69 patients with ischemic stroke treated with intra-arterial therapy was carried out. Cohort 1 included patients treated before implementation of a new stroke protocol, and cohort 2 after implementation. Angiographic outcome was graded using the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcomes were assessed using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).
  
  
  RESULTS
  Primary outcomes comparing cohorts demonstrated decreased arrival-to-puncture time (cohort 2: 104 vs cohort 1: 181 min, p<0.001), similar TICI 2b/3 rates (86.5% vs 81.3%, p=0.5530), and similar percentage of patients with discharge mRS 0-2 (18.9% vs 21.9%, p=0.7740). Notable secondary outcomes for cohort 2 included decreased puncture-to-first pass time (34 vs 53 min, p <0.001), increased TICI 3 rates (37.8% vs 18.8%, p=0.0290), a trend toward greater improvements in NIHSS on postoperative day 1 (6.8 vs 2.6, p=0.0980) and discharge (9.5 vs 6.7, p=0.1130), and a trend toward increased percentage of patients discharged with mRS 0-3 (48.6% vs 34.4%, p=0.3280 NS). There were similar rates of symptomatic intracerebral hemorrhage (10.8% vs 9.4%, p=0.9570) and death (10.8% vs 15.6%, p=0.5530).
  
  
  CONCLUSIONS
  An interdisciplinary and rapid response to the emergence of strong clinical evidence can result in dramatic changes in a large healthcare system.
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Mascitelli
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Hazem
authors.initials: H
authors.lastname: Shoirah
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Reade A
authors.initials: RA
authors.lastname: De Leacy
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Furtado
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Paramasivam
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Eric K
authors.initials: EK
authors.lastname: Oermann
authors.affiliation: Department of Neurosurgery, Keck Medicine of USC, Los Angeles, California, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Mack
authors.affiliation: Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Tuhrim
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Neha S
authors.initials: NS
authors.lastname: Dangayach
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Meyer
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Joshua B
authors.initials: JB
authors.lastname: Bederson
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mocco
authors.affiliation: Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
authors.forename: Johanna T
authors.initials: JT
authors.lastname: Fifi
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000628:therapy*; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000379:methods* / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods / Q000639:trends; D016896:Treatment Outcome
keywords: Stroke; Thrombectomy