title: Intra-Arterial Therapy for Acute Stroke and the Effect of Technological Advances on Recanalization: Findings in a Community Hospital.
abstract: BACKGROUND
  Recent randomized controlled studies have shown improvement in recanalization outcomes when physicians use the latest intra-arterial therapy devices in patients with acute, large-vessel, intracranial occlusions. The goal of this study was to explore how new procedures affected degree of and time to recanalization at a single center over the past 12 years as technology has improved.
  
  
  METHODS
  Patients were included in the study if they had a large or medium intracranial vessel occlusion and had undergone intra-arterial therapy for acute stroke during the period 2002-2013. Therapies were categorized as intra-arterial thrombolysis with tissue plasminogen activator (IA tPA), mechanical thrombectomy using 1st-generation devices (Merci and Penumbra), or mechanical thrombectomy using 2nd-generation devices (stent-trievers). Recanalization was defined using a modified Thrombolysis in Cerebral Infarction (TICI) scale.
  
  
  RESULTS
  Primary treatment was IA tPA in 24 (12.4%) patients, 1st-generation devices in 128 (66.0%) patients, and 2nd-generation devices in 42 (21.6%) patients. TICI 2b was achieved in 7 (29.2%) patients treated with IA tPA, in 79 (61.7%) patients treated with 1st-generation devices, and in 38 (90.5%) patients treated with 2nd-generation devices. Compared to patients treated with IA tPA, patients treated with 2nd-generation devices were more likely to reach TICI 2b recanalization (odds ratio, 11.66; 95% CI, 1.56-87.01), and they did so in shorter times.
  
  
  CONCLUSIONS
  Technological advances over 12 years in endovascular stroke treatments significantly improved the chance of and reduced time to achieving TICI 2b recanalization in our community hospital. This shows the importance of adopting new technologies in a rapidly evolving field in order to provide the best-practice standard of care for the people of our region.
authors.affiliation: neurointerventionalist, Mission Health Neurosciences, Asheville, North Carolina jam93g@gmail.com.
authors.forename: Jonas H
authors.initials: JH
authors.lastname: Goldstein
authors.affiliation: biostatistician, Research Institute, Mission Hospital, Asheville, North Carolina.
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Denslow
authors.affiliation: research assistant, Mission Health Neurosciences, Asheville, North Carolina.
authors.forename: Samuel J
authors.initials: SJ
authors.lastname: Goldstein
authors.affiliation: neurointerventionalist, Mission Health Neurosciences, Asheville, North Carolina.
authors.forename: William F
authors.initials: WF
authors.lastname: Marx
authors.affiliation: neurointerventionalist, Mission Health Neurosciences, Asheville, North Carolina.
authors.forename: John G
authors.initials: JG
authors.lastname: Short
authors.affiliation: stroke neurologist, Mission Health Neurosciences, Asheville, North Carolina.
authors.forename: Reid D
authors.initials: RD
authors.lastname: Taylor
authors.affiliation: stroke neurologist, Mission Health Neurosciences, Asheville, North Carolina.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Schneider
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002548:Cerebral Revascularization / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000150:complications; D062069:Inventions; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D009657:North Carolina; D017063:Outcome Assessment, Health Care; D058996:Quality Improvement; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator