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Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force

H.J. Cloft, A. Rabinstein, G. Lanzino and D.F. Kallmes
American Journal of Neuroradiology March 2009, 30 (3) 453-458; DOI: https://doi.org/10.3174/ajnr.A1462
H.J. Cloft
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A. Rabinstein
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G. Lanzino
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D.F. Kallmes
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    Table 1:

    Outcomes of intra-arterial therapy in major trials

    StudyMean Baseline NIHSSRecanalization (TIMI 2 or 3)Good Outcome at 90 Days (mRS 0–2)Mortality at 90 DaysSymptomatic ICH
    Intra-arterial therapy
        PROACT91758%NA27%15%
        PROACT II61766%40%25%10%
        IMS-I81856%43%16%6%
        IMS-II51960%46%16%10%
        MERCI72246%28%44%8%
        Multi MERCI41968%36%34%10%
        Penumbra pivotal study1882%25%33%11%
    Nonarterial therapy
        PROACT91914%NA43%7%
        PROACT II2 control1718%25%27%2%
        NINDS placebo*518NA28%24%1%
        NINDS IV rtPA*518NA39%21%7%
    • Note:—NIHSS indicates National Institutes of Health Stroke Scale; TIMI, Thrombolysis in Myocardial Infarction trial; ICH, intracranial hemorrhage; mRS, modified Rankin Scale; PROACT, Prolyse in Acute Cerebral Thromboembolism trial; IMS, Interventional Management of Stroke trials; MERCI, Mechanical Embolus Removal in Cerebral Ischemia trials; NINDS, National Institute of Neurological Disorders and Stroke; NA, not available.

    • * NINDS is subgroup of patients with an NIHSS of 10 or more.

    • View popup
    Table 2:

    Demand for thrombolysis in the United States based on the published literature

    ReportCases per Year per Hospital*
    Intra-arterial treatment, multicenter trials
        PROACT, 199891 (0–10)
        PROACT II, 199961 (0–17)
        EMS, 1999665 (2–10)
        IMS-I, 200487 (0–27)
        MERCI, 200573 (0–9)
        IMS-II, 200752 (NA)
        Multi MERCI, 200845 (0–20)
    Intra-arterial treatment, single center
        Barnwell et al, 1994197
        Suarez et al, 19991815
        Jahan et al, 1999675
        Ernst et al, 20002017
        Hill et al, 2002214
        Ramee et al, 2004683
        Choi et al, 2006229
        Devlin et al, 20072330
        Kim et al, 20071713
        Wolfe et al, 20081615
    Intravenous treatment, multicenter trials
        NINDS, 19956920
        ATLANTIS, 1999701
        STARS, 2000714
    Intravenous treatment, single center
        Chiu et al, 19987230
        Zweifler et al, 1998739
        Grotta et al, 20017461
        Kahn et al, 20057526
        Wolfe et al, 20081645
        Arenillas et al7646
    • Note:—PROACT indicates Prolyse in Acute Cerebral Thromboembolism trial; EMS, Emergency Management of Stroke trial; IMS, Interventional Management of Stroke trials; MERCI, Mechanical Embolus Removal in Cerebral Ischemia trials; NINDS, National Institute of Neurological Disorders and Stroke; ATLANTIS, Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke trial; STARS, Standard Treatment with Alteplase to Reverse Stroke study.

    • * Numbers in parentheses are ranges.

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American Journal of Neuroradiology: 30 (3)
American Journal of Neuroradiology
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H.J. Cloft, A. Rabinstein, G. Lanzino, D.F. Kallmes
Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force
American Journal of Neuroradiology Mar 2009, 30 (3) 453-458; DOI: 10.3174/ajnr.A1462

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Intra-Arterial Stroke Therapy: An Assessment of Demand and Available Work Force
H.J. Cloft, A. Rabinstein, G. Lanzino, D.F. Kallmes
American Journal of Neuroradiology Mar 2009, 30 (3) 453-458; DOI: 10.3174/ajnr.A1462
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    • Abstract
    • Who Needs Intra-Arterial Ischemic Stroke Therapy?
    • How Many Patients Will Need Intra-arterial Therapy?
    • Who Provides Care for Patients with Acute Ischemic Stroke?
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    • References
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