Public Health Urgency Created by the Success of Mechanical Thrombectomy Studies in Stroke
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Stroke is a major cause of death and disability.1 Each year, >15 million strokes occur worldwide. In addition, ≈35% of strokes are caused by potentially reversible large-vessel occlusion. Until 2015, no scientifically proven interventional treatment strategies were available to address this type of stroke. In the early 1980s, reports of dramatic clinical improvement with reopening of large-vessel occlusions were published. However, patient volumes were small, tools were crude, and results were inconsistent. The first significant advance in the treatment of this condition was the US Food and Drug Administration’s approval of intravenous tissue plasminogen activator in 1996. With tissue plasminogen activator, only a small subset was eligible for this therapy, and most people with major strokes fared poorly.2 Subsequent development of the Merci device (Stryker) gave birth to the field of invasive clot retrieval for acute ischemic stroke (AIS). MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) first documented transformational beneficial results for clot retrieval.3 This study was followed by 4 more positive trials reported in 2015 and began a new era in stroke care.3
The new data have resulted in a potentially cataclysmic gap between patient need and available expertise. Given the recent study results, the “gold standard” treatment is now rapid mechanical revascularization and mirrors the last 2 decades of acute myocardial infarction care. In contrast to acute myocardial infarction, however, we now face an overwhelming shortage of neurointerventionists to support the shift in AIS treatment. Therefore, we believe interventionists from other training backgrounds must now fill this gap in AIS, and a collaborative …