Position Statement

AANS/CNS Position Statement on Stroke Center Volumes

  • AANS/CNS Washington Office

Position Statement on Stroke Center Volumes

Initial investigations into the administration of intravenous thrombolytic therapy for intracerebral arterial occlusion, demonstrated improvement in acute ischemic stroke (AIS) outcomes when these medications were provided within the 3 to 4.5-hour time window. 1,2 To maximize efficiency and meet this time window, organized “brain attack” teams were created and, subsequently, the “stroke center of excellence.” The resulting benefits to the patient suffering a stroke were similar to those realized when the system of care concept was applied to trauma and cardiac emergencies. This is timely, as in the United States alone, the incidence of AIS is approximately 750,000 patients annually, and this
rate is expected to increase by 25% in the next 20 years.3

Further evolution in AIS systems of care occurred between 2014 through 2017. This evolution was catalyzed by improvements in endovascular devices. What followed were evidence-based data. These data demonstrated that patients with large vessel occlusions (LVO) of the anterior cerebral circulation were provided significant improvements in outcomes when access to endovascular care was possible. Extended time windows of up to 12 hours from symptoms onset were the result. The HERMES meta-analysis best summarizes the impact of mechanical thrombectomy — an interventional procedure to remove a blood clot from inside cerebral arteries — as “of benefit to most patients with acute ischemic stroke caused by occlusion of the proximal anterior circulation, irrespective of patient characteristics or geographical location.”4

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