Interdisciplinary rendez-vous approach in endovascular stroke treatment a new concept to accelerate mechanical thrombectomy in primary stroke centers

Abstract

Abstract Background/Introduction Prompt endovascular treatment of patients with stroke due to intracranial Large Vessel Occlusion (LVO) is a major challenge especially in rural areas because neurointerventionalists are usually not available. As a result, treatment is delayed, and clinical outcomes are worse compared with patients primarily treated in comprehensive stroke centers (CSC). Purpose To address this problem, we present a new concept in which interdisciplinary, on-site endovascular treatment is performed in a Primary Stroke Center (PSC) by a team of interventional cardiologists and neuroradiologists: the Rendez-Vous approach. Methods Twenty-seven patients with LVO who underwent interdisciplinary thrombectomy on-site at the PSC as part of the Rendez-Vous concept were compared with 72 patients who were transferred from a PSCs to the CSC for thrombectomy when diagnosed with LVO in terms of temporal sequences and clinical outcomes. The crucial aspect of the concept is that the patient is not transferred for the intervention but is treated on site and the cardiologist actively starts the intervention while the neurointerventionalist rushes to the site as soon as possible. Results Patients treated on-site at the PSC as part of the Rendez-Vous approach were managed as successfully and without an increase in complication rates compared with patients treated secondarily at a CSC (91.7% successful interventions in Rendez-Vous vs. 87.3% in control group, p=0.57). The time from diagnosis of LVO to groin puncture was reduced by 68.3 minutes with the Rendez-Vous concept (p<0.01). Regarding the clinical outcome, a functionally independent status was achieved in 37.0 % in the Rendez-Vous group and in 19.4% in the control group (p=0.012). Conclusion Interdisciplinary teamwork between cardiology and interventional neuroradiology in rural PSCs leads to shorter times to successful reperfusion in patients with severe ischemic stroke due to LVO. This has a potentially positive impact on the clinical outcome of stroke patients and should be considered as a possible care concept in similar stroke networks.Rendez-Vous concept in stroke management