title: Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care.
abstract: Five recently published randomized trials of endovascular therapy versus medical management, including intravenous thrombolysis, demonstrated strong positive data in support of intra-arterial thrombectomy procedures. The American Heart Association/American Stroke Association released a focused update of the 2013 guidelines on the early management of acute ischemic strokes to specifically incorporate the findings of the 5 "positive" trials. In this review, we examine the key results of those trials and the principal changes in the updated guidelines. We discuss the ongoing and future changes in stroke systems of care, with an emphasis on the role of pre-hospital stroke triage, interhospital transfer, and the 2 main levels of stroke center certification (primary and comprehensive).
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Departments of Neurology and Neurosurgery, University of South Florida College of Medicine, Tampa, Florida.
authors.forename: Maxim
authors.initials: M
authors.lastname: Mokin
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York.
authors.forename: Kenneth V
authors.initials: KV
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; Jacobs Institute, Buffalo, New York.
authors.forename: Adnan H
authors.initials: AH
authors.lastname: Siddiqui
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York.
authors.forename: Elad I
authors.initials: EI
authors.lastname: Levy
authors.affiliation: Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York; Jacobs Institute, Buffalo, New York. Electronic address: lhopkins@ubns.com.
authors.forename: L Nelson
authors.initials: LN
authors.lastname: Hopkins
mesh_terms: D002568:Certification; D002985:Clinical Protocols; D004632:Emergency Medical Services; D057510:Endovascular Procedures; D006297:Health Services Accessibility; D006761:Hospitals / Q000592:standards; D006801:Humans; D009460:Neurologic Examination; D010360:Patient Transfer; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment
keywords: acute ischemic stroke; endovascular therapy; randomized clinical trials; stroke centers; thrombectomy