In just the short time since the DAWN trial results were released in November 2017 and set the new standard for treating eligible patients with large-vessel occlusions with mechanical thrombectomy within 6-24 hours, stroke admissions and transfers to the comprehensive stroke center at UPMC from November 2017 to February 2018 rose 18% from the same time period a year before, including a 5% rise in telemedicine transfers, Dr. Wechsler said in a presentation at the meeting. These additional cases led to a 35% increase in thrombectomy cases.
Putting the matter into additional perspective, in the time period from November 2014 to February 2017, 30% of all 2,667 acute ischemic stroke patients seen at UPMC would have met DAWN trial inclusion criteria with a 6- to 24-hour window, but less than 3% of all the strokes seen at UPMC would have qualified for thrombectomy under criteria from the DAWN and DEFUSE-3 trials. That makes it imperative for comprehensive stroke centers to triage cases and receive only those that require endovascular treatment, he said.
Meeting the already-rising needs for triaging acute ischemic stroke patients arriving in the window of 6-24 hours will be difficult, considering that there are about 800,000 new strokes per year in the United States but only 1,100 vascular neurologists, nearly 1,100 primary stroke centers, and only 110 comprehensive stroke centers at which endovascular thrombectomy treatment may be offered. As of 2016, he noted that there also were only 74 U.S. stroke fellowship programs with 123 positions offered, of which 34% went unfilled.