Published on October 24, 2018

Reading Hospital Physician Led International Revision of Stroke Treatment Protocols

Reading Hospital interventional radiologist David Sacks, MD, led a group of 12 international medical societies to propose new treatment guidelines for stroke patients. These new protocols are expected to lead to better treatment outcomes and independence for stroke patients.

The guidelines, published in the April issue of the Journal of Vascular and Interventional Radiology, were endorsed by the Society of Intervention Radiology (SIR) and 11 other medical societies. Dr. Sacks has been involved with this process since 2011 and was chair of SIR for this endorsement.

"It was time to update the processes of caring for stroke patients to reflect advancements in stroke interventions," said Dr. Sacks. "These guidelines will help us in Reading Hospital's Advanced Primary Stroke Center and physicians in other hospitals to gauge their treatment versus other clinicians' and expert study results."

The new guidelines propose shorter time frames for removal of blood clots in the brain and treatments that can help patients return to independent living more quickly. Fifteen metrics for stroke protocols are proposed, covering procedures such as treatment, collection of data, time intervals for the start of treatment and procedures, procedural success rates, postprocedural imaging, and clinical outcomes. Dr. Sacks said that stroke centers and many individual health care facilities are expected to adopt the new guidelines, which could become part of the certification requirements for specialty stroke care.

The new protocols reflect the importance of opening blocked arteries as quickly as possible, Dr. Sacks explained, stressing that patient care should begin as soon as the medical team is aware that a possible stroke patient is in transport to the facility.

"A lot needs to happen quickly and simultaneously to prepare for best outcomes for the stroke patient," said Dr. Sacks. "At Reading Hospital, for example, EMS calls us as soon as they see someone with a possible stroke. With the use of telemedicine, our Emergency Department doctors can begin immediate treatment during transport. We have a CAT scan technician ready to see the patient upon arrival, and our team, including an interventional radiologist or interventional neurosurgeon, a stroke neurologist, and an anesthesiologist, are ready to begin any necessary procedures."

In order to get the best result for a stroke patient, the medical team seeks to control as many factors as possible. Some factors, he noted, are out of their control, such as the age of the patient, the location of clot, the size of the clot, and the severity of the symptoms.  The factors under physicians' control include the speed and success of removing the clot.  "We know that the percentage of time we can successfully open an artery and how quickly we can open it are strongly related to the likelihood of the patient having a good outcome. These new stroke benchmarks give doctors and hospitals a way to measure their own performance and look for ways to do it better and faster," said Dr. Sacks