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Riverside Methodist Hospital Columbus, Ohio Nirav Vora, MD Interventional Neurology 90839971.AA | Page 3 of 32

Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

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Page 1: Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

Riverside Methodist Hospital Columbus, Ohio

Nirav Vora, MD Interventional Neurology

90839971.AA | Page 3 of 32

Page 2: Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

Riverside Methodist Hospital §  Stroke Program Development 12 yr §  First in Ohio

§  Primary Stroke center 2004 §  Comprehensive stroke center 2012 §  Ohio Health Stroke Network 21 sites

§  2000+ stroke discharges 2012

90839971.AA | Page 4 of 32

Page 3: Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

RMH Stent Retrievers 1 year + (3/12-5/13)

79 Anterior Circulation pts

§  Age av 68 + 15 yrs

§  NIHSS av 17.5

§  ASPECTS score med 9

§  Tandem occlusions 10

§  Intracranial ICA 20

§  M1, M2 39,10

Page 4: Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

RMH Stent Retrievers 79 Consecutive Patients

§  87% TICI 2b or 3 (69/79)

§  51% 1 pass (40/79) §  mRS 0-2 in single pass patients (52%) (21/40)

§  1.2% ICH(parenchymal) (1/79) §  43% mRS 0-2 (34/79)

§  Good outcome in those treated with IV tPA 52% §  1.9 average passes

Page 5: Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

Case Example

Page 6: Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

Summary

§  Key interventional predictors of good neurological outcome §  Use of a stent retriever device as first line therapy §  Use of a balloon guide catheter §  Procedural speed to TICI 3 recanalization

§  Key pre-interventional predictors of good neurological outcomes §  Speed to Intervention: ASPECTS score >7 AND

Incoming NIHSS §  Use of IV-TPA prior to intervention §  Local anesthesia

Page 7: Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

Conclusions

•  Key interventional predictors of good neurological outcome •  Use of a stent retriever device as first line therapy •  Use of a balloon guide catheter •  Procedural speed to TICI 3 recanalization

•  Key pre-interventional predictors of good neurological outcomes •  Speed to Intervention: ASPECTS score >7 AND

Incoming NIHSS •  Use of IV-TPA prior to intervention •  Local anesthesia

Page 8: Riverside Methodist Hospital - SVIN · 2014-04-22 · Riverside Methodist Hospital! Stroke Program Development 12 yr ! First in Ohio ! Primary Stroke center 2004 ! Comprehensive stroke

Q&A