Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Mar;18(1):4-13.
doi: 10.5114/aic.2022.115269. Epub 2022 Apr 11.

Acute ischemic stroke treatment model for Poland in the mechanical thrombectomy era - which way to go?

Krzysztof Pawłowski  1 , Artur Dziadkiewicz  2 , Jacek Klaudel  3 , Alicja Mączkowiak  2 , Marek Szołkiewicz  1
Affiliations
Review

Acute ischemic stroke treatment model for Poland in the mechanical thrombectomy era - which way to go?

Krzysztof Pawłowski et al. Postepy Kardiol Interwencyjnej. 2022 Mar.

Abstract

The interventional treatment of acute ischemic stroke with large vessel occlusion has revolutionized patient care in recent years. The Mechanical Thrombectomy Pilot Program in Poland is due to end soon. It seems the right time to summarize the achievements and name the problems of a centralized stroke care system and decide what future model of treatment and transportation to implement. In order to provide the best care for our patients, it is crucial to establish the actual needs in stroke and tailor the mechanical thrombectomy system structure accordingly. The analysis of data from well-organized health systems in the world suggests that to deliver adequate numbers of mechanical thrombectomy to stroke patients in Poland, we would need to at least double the number of procedures currently performed. To achieve this, an essential system reorganization and adjustments are required, with special emphasis on the number of mechanical thrombectomy centers and transportation models. The strengths and weaknesses of two dominant transportation models (mothership and drip-and-ship) are herein discussed, and a proposal on how to build an efficient and cost-effective mechanical thrombectomy stroke network in Poland is put forward. The article is an invitation to open an interdisciplinary discussion on the best treatment model of acute ischemic stroke patients requiring mechanical thrombectomy in Poland.

Keywords: acute ischemic stroke; mechanical thrombectomy; stroke network modeling; stroke transportation model; thrombectomy-capable stroke center.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Acute ischemic stroke patient pathways in different transportation models CT – computed tomography, CTA – computed tomography angiography, PSC – Primary Stroke Center, CSC – Comprehensive Stroke Center, LVO – large vessel occlusion.
Figure 2
Figure 2
Comparison of time intervals in two dominant transportation models PSC – primary stroke center, CSC – comprehensive stroke center, DS – drip-and-ship, MS – mothership.
Figure 3
Figure 3
‘No country for old men with stroke’ – map of Poland’s presently active 20 Comprehensive Stroke Centers (CSC), surrounded by 50-km radius areas with around 60% of country’s area potentially beyond fast access to mechanical thrombectomy (MT) services
See this image and copyright information in PMC

References

    1. Berkhemer OA, Fransen PS, Beumer D, et al. . MR CLEAN Investigators . A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11-20. - PubMed
    1. Campbell BC, Mitchell PJ, Kleinig TJ, et al. . EXTEND-IA Investigators . Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009-18. - PubMed
    1. Jovin TG, Chamorro A, Cobo E, et al. . REVASCAT Trial Investigators . Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296-306. - PubMed
    1. Goyal M, Demchuk AM, Menon BK, et al. . ESCAPE Trial Investigators . Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019-30. - PubMed
    1. Saver JL, Goyal M, Bonafe Aet al. . Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285-95. - PubMed