Acute Neurointervention for LVO StrokeBaptist Health Lexington Experience

2015 2016 2017 2018 (Jan-Oct)

Patients 56 67 70 (11 inpatients) 77 (12 inpatients)

0

2

4

6

8

10

12

14

DEC

-20

15

JAN

-20

16

FEB

-20

16

MA

R-2

01

6

AP

R-2

01

6

MA

Y-2

01

6

JUN

-20

16

JUL-

20

16

AU

G-2

01

6

SEP

-20

16

OC

T-2

01

6

NO

V-2

01

6

DEC

-20

16

JAN

-20

17

FEB

-20

17

MA

R-2

01

7

AP

R-2

01

7

MA

Y-2

01

7

JUN

-20

17

JUL-

20

17

AU

G-2

01

7

SEP

-20

17

OC

T-2

01

7

NO

V-2

01

7

DEC

-20

17

JAN

-20

18

FEB

-20

18

MA

R-2

01

8

AP

R-2

01

8

MA

Y-2

01

8

JUN

-20

18

JUL-

20

18

AU

G-2

01

8

SEP

-20

18

OC

T-2

01

8

Number of Neurointerventional Stroke Patients/Month

Averages 2016 2017 2018 (Jan-Oct)

Presenting NIHSS 15.5 15.7 14.3

Door to Head CT 5 min 8 min 5 min

Door to Groin Access

69 min 81 min 75 min

Door to 1st Pass Thrombectomy

91 min 100 min 96 min

< 90 min 2017(50/59)

< 60 min 2017(14/59)

< 90 min 2018(55/65)

< 60 min 2018(22/65)

84.70

23.70

84.60

33.80

DOOR TO PUNCTUREPERCENTAGE MEETING GOALS

< 120 min 2017(48/59)

< 90 min 2017(30/59)

< 120 min 2018(57/65)

< 90 min 2018(32/65)

81.30

51.80

87.70

49.20

DOOR TO 1ST PASS THROMBECTOMYPERCENTAGE MEETING GOALS

Acute Neurointervention for LVO StrokeBaptist Health Lexington Times

2016 2017 2018 (Jan-Oct)

TICI 2b/3 revascularization

76% 90 % 83%

Symptomatic ICH 4% 2.9% 2.6%

30 day Mortality 11% 25% 20%

90 day f/u mRS 0-2 63% 52% 54%

Acute Neurointervention for LVO StrokeBaptist Health Lexington Outcomes

4.00%

2.90%2.60%

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

2016 2017 2018

Symptomatic ICH

63%

52% 54%

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

2016 2017 2018

90 day Good Clinical Outcome

52% 54%

70%65%

0.00

20.00

40.00

60.00

80.00

90 day Good Clinical OutcomeComparing “trial eligible” patients

90 day Good Clinical Outcome 90 day Clinical "Trial Eligible"

76%

90%

83%

65.00

70.00

75.00

80.00

85.00

90.00

95.00

2016 2017 2018

Successful Recanalization

11%

25%

20%

0.00

5.00

10.00

15.00

20.00

25.00

30.00

2016 2017 2018

90 day Mortality*** 2 0 1 7 / 2 0 1 8 I n c lu de "a l l c o m e r s" ( B as i lar o c c lu s io n ,

D A W N e l ig ib le , H igh base l in e M R S , R an k in S h i f t , T an de m Le s io n s)

Cerebral Aneurysm & SAH

2015 2016 2017 2018 (Jan-current)

SAH 7 patients 20 patients 25 patients2 20 patients3

Endovascular:Clip 7:0 20:0 17:0 9:0

In-hospital mortality 14% (1/7) 10% (2/20) 8% (2/25)4 25% (5/20)5

30 day re-admission 0% (0/6) 6% (1/18) 4% (1/23) 0% (0/15)

30 day mortality 14% (1/7) 10% (2/20) 8% (2/25) 4 25% (5/20)5

Unruptured 36 patients 28 patients 38 aneurysms (34 patients) 39 aneurysms (34 patients)

Endovascular:Clip 35:1 32:6 35:3 39:0

In-hospital mortality 0% (0/36) 0% (0/28) 0% (0/34) 0% (0/34)

30 day CVA or readmission 8% (3/36)1 0% (0/26) 0% (0/34) 3% (1/34)6

30 day mortality 0% (0/36) 0% (0/26) 0% (0/34) 0% (0/34)

4

1. Stent thrombosis/Plavix hyporesponder, Spinal cord CVA with PCA embo, Headache2. 7 perimesencephalic SAH, 1 High-grade hemorrhage/comfort measures only3. 8 perimesencephalic SAH, 3 High-grade hemorrhage/comfort measures only4. 1 patients H/H 4, comfort measures only in 15. 2 patients H/H > 3, comfort measures only in 36. Thrombosed LVIS Jr Stent and CVA

Cerebral AVM’s

2015 2016 2017 2018 (Jan-Oct)

Treatments/PatientsUnruptured:Ruptured

3/32:1

6/64:2

14/1210:2

7/65:1

In-hospital mortality 33% (1/3) 0% (0/6) 0% (0/12) 0% (0/6)

30 day re-admission 0% (0/2) 0% (0/6) 0% (0/12) 0% (0/6)

30 day mortality 33% (1/3) 0% (0/6) 0% (0/12) 0% (0/6)

5

Treatment includes:- Surgical resection- Embolization- Stereotactic Radiosurgery (CyberKnife)

6

Intracranial Atherosclerotic DiseaseAngioplasty & Stenting

2015 2016 2017 2018 (Jan-Oct)

Patients (Emergent) 9 (2) 7 (2) 8 (1) 7 (3)

Wingspan (WEAVE) 6 (6) 5 (3) 0 1

Hospital Mortality 11% (1/9) 1 0% (0/7) 0% (0/7) 0% (0/7)

30 day CVA or Readmission 13% (1/8)1 0% (0/7) 0% (0/7) 0% (0/7)

30 day Mortality 11% (1/9) 1 0% (0/7) 0% (0/7) 14% (1/7)2

1. Part of Acute Stroke/Thrombectomy case2. Presented with GI bleed (NSAID abuse, DDD Lspine) & thrombosed stent

Carotid Artery DiseaseCarotid Stenting

2015 2016 2017 2018 (Jan-Oct)

Symptomatic Carotid Stenosis

46 patients 28 patients 41 patients 23 patients

30 day CVA 2% (1/46)1 4% (1/25)2 5% (2/41)5,6 4% (1/23)5

30 day mortality 0% 4% (1/25)3 2% (1/41)6 0%

Asymptomatic CarotidStenosis

39 patients 27 patients 34 patients 21 patients

30 day CVA 0% 4% (1/25)4 0% 0%

30 day mortality 0% 0% 0% 0%

7

1. Factor V Leiden Deficiency2. ICH3. Respiratory Failure, DNR status4. Plavix hyporesponder5. New/extension of CVA6. Massive ICH 9 days post CAS