SILC Press Release
SVIN DEVELOPS CONSENSUS CRITERIA FOR STANDARDIZING STROKE INFRASTRUCTURE TO IMPROVE ACCESS TO CLOT RETRIEVAL THERAPIES
The Society for Vascular and Interventional Neurology (SVIN) has developed Stroke Interventional Laboratory Consensus (SILC) criteria to standardize stroke interventional laboratories for safe, effective, and timely stroke care worldwide.
"Brain attack care is now exploding with new devices and options, just as heart attack care grew rapidly in the 1990s," said Tanzila Shams, M.D., and lead author of a report on the criteria published February 26 in Interventional Neurology. "There is an unmet need to establish a new national standard to provide optimal, timely stroke care to all patients suffering from acute ischemic strokes."
The SILC criteria reflect the need to clearly distinguish stroke interventional lab capabilities at a time of rapid advancements in stroke treatment, including the use of stent retrieval devices, vacuum suction devices, and clot-busting drugs to save lives and reduce long-term damage to the brain. "Our hope is that these consensus criteria will provide the roadmap for growth of high quality stroke intervention labs worldwide similar to the growth of cardiac catheterization labs," said SVIN past-president Tudor Jovin, M.D., co-author of the report.
To advance this goal, SVIN developed a "7M" management approach for standardizing stroke infrastructure and includes:
- Manpower: personnel including roles of medical and administrative directors, interventional technologists, interventional nurses, physician extenders, and all the key stakeholders in the stroke chain of survival;
- Machines: resources needed in terms of physical facilities, and angiography equipment;
- Materials: medical device inventory, medications, and angiography supplies;
- Methods: standardized protocols for stroke workflow optimization;
- Metrics (volume): existing credentialing criteria for facilities and stroke interventionalists;
- Metrics (quality): benchmarks for quality assurance; and
- Metrics (safety): radiation and procedural safety practices;
"National efforts in the uniform organization, accreditation, and certification of stroke intervention practices are more important than ever," said Vallabh Janardhan, M.D., and senior author of the report. "For effective stroke therapy to reach millions of people, we need to have the right infrastructure in place."
Several societies and organizations, including the National Institute of Neurological Disorders and Stroke (NINDS) Brain Attack Coalition, American Heart Association/ American Stroke Association (AHA/ASA), and stroke center certifying bodies including The Joint Commission, Det Norske Veritas (DNV) Healthcare, and Hospital Facilities Accreditation Program (HFAP) endorse the systematic organization of stroke care operations at a national level.
According to national studies, approximately 130,000 Americans die from strokes each year, most caused when a clot blocks the flow of blood into the brain. In 1996, the Food and Drug Administration (FDA) approved the use of the clot-dissolving drug intravenous tissue plasminogen activator (IV r-tpa) for emergency treatment for patients within three hours of a stroke.
In the past year, a series of landmark studies have demonstrated the benefit of catheter-based interventions for treating stroke patients with large vessel occlusions. These studies have shown that using stent retrieval devices by themselves or with vacuum aspirators or clot-busting medications are highly effective in removing blockages and restoring blood circulation to the brain, even very severe strokes. “Standardizing stroke interventional labs will increase treatment rates and help achieve SVIN’s Mission 2020 goal of 200,000 clot retrieval procedures worldwide by the year 2020,” said Dileep Yavagal, M.D., SVIN past-president, and co-author of the report.
"We now have exciting new therapies for brain attacks, such as retrievable stents and vacuum suction devices that are similar to balloons and stents for heart attacks," said Janardhan. "But these technology innovations need to be supported by the appropriate stroke interventional lab infrastructure so that patients receive timely care.”
Currently, there are 1,476 primary stroke centers in the U.S. that can provide clot-busting medications, and more than 170 comprehensive stroke centers whose capabilities include neurosurgical and catheter interventional treatments as well as medications.
"Although this tiered system of stroke centers has improved outcomes in the treatment of strokes, more emphasis is needed on the development and operations of the stroke intervention lab within a stroke center," said Janardhan. For instance, standardization is needed on emergency triage procedures for stroke patients, stroke interventional protocols and equipping, staffing and managing a stroke interventional lab.
"As we enter a new era of stroke care, national standards are needed to direct patients, families and EMS to the right center," said Raul Nogueira, M.D., SVIN president. "We believe SVIN's report on consensus criteria can provide a framework for developing those standards, leading to a higher level of care and better patient outcomes."
Download the Report
Please click here to view a downloadable copy of the Interventional Neurology report, “Society of Vascular and Interventional Neurology (SVIN) Stroke Interventional Laboratory Consensus (SILC) Criteria: A 7M Management Approach to Developing a Stroke Interventional Laboratory in the Era of Stroke Thrombectomy for Large Vessel Occlusions,” by Shams T, Zaidat OO, Yavagal DR, Xavier AR, Jovin TG, and Janardhan V.
About the Society of Vascular & Interventional Neurology (SVIN)
The SVIN traces its roots to the neurologist Egaz Moniz, who performed the first cerebral angiogram in 1927. Stroke and critical care neurologists performing catheter-based endovascular interventions, including clot retrieval, are now an integral part of the multidisciplinary field of endovascular surgical neuroradiology (aka interventional neurology). In 2002, the Accreditation Council for Graduate Medical Education (ACGME) formalized the eligibility of neurologists to obtain training in “Endovascular Surgical Neuroradiology” along with neurosurgeons and neuroradiologists. In 2006, this growing group of stroke and interventional neurologists formed the Society for Vascular and Interventional Neurology.