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Thrombectomy stroke centers: The current threat to regionalizing stroke care

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The Joint Commission (JC), in collaboration with the American Heart Association (AHA), recently announced a new stroke center certification for Thrombectomy Capable Stroke Centers (TSCs).1 The criteria for TSC accreditation are less stringent than those for existing Comprehensive Stroke Centers (CSCs) with focus specifically on the delivery of endovascular acute ischemic stroke care. The accrediting organizations state that this designation originated in response to the ‘need to identify rigorous standards for performing endovascular thrombectomy procedures’.1

There is no dispute of the value in identifing rigorous endovascular thrombectomy standards. Unfortunately, this new designation does not meet a reasonable threshold for rigor. Although these centers may be thrombectomy ‘capable’, the evidence suggests that the process and numerical requirements currently proposed for accreditation are insufficient to yield the favorable patient outcomes reported in recent randomized controlled trials. Further, the new guidelines do not call for adequate resources to support the comprehensive care of emergent large vessel occlusion (ELVO) stroke patients. Concerns were recently raised by the Brain Attack and Cerebrovascular Coalitions about this new designation.

Consistently successful treatment of the most severely affected stroke patients requires not just capability, but excellence as well. It is possible that TSCs may have value in specific systems of care and/or limited parts of the country with unique geographic and urban spatial considerations. For instance, incorporation of hospitals under this designation might serve an unmet regional need or strengthen an existing spoke and hub model within a unified hospital enterprise. Even in such circumstances, requirements should ensure that TSCs are staffed with experienced and specialized stroke/critical care neurologists and neuroendovascular surgeons who are supported by services capable of delivering high-level periprocedural care. If hospital facilities are allowed to pursue this designation independent of regional considerations or existing networks, it is highly likely that large …

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