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Practice makes perfect: establishing reasonable minimum thrombectomy volume requirements for stroke centers
  1. Kyle M Fargen1,
  2. David J Fiorella2,
  3. J Mocco3
  1. 1Department of Neurological Surgery, Wake Forest University, Winston-Salem, North Carolina, USA
  2. 2Department of Neurosurgery, Stony Brook University, Stony Brook, New York, USA
  3. 3Department of Neurosurgery, Mount Sinai Hospital, New York, USA
  1. Correspondence to Dr Kyle M Fargen, Department of Neurological Surgery, Wake ForestUniversity, Winston-Salem, North Carolina 27109, USA; kfargen{at}wakehealth.edu

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Introduction

Recently, seven randomized controlled trials were published showing benefit to neurothrombectomy (NT) in the setting of anterior circulation emergent large vessel occlusion (ELVO).1–7 Accordingly, the American Heart Association/American Stroke Association has updated societal guidelines and provided a class 1, level of evidence A recommendation that NT be performed in patients with an ELVO who meet appropriate criteria.8 Subsequently, a recent national survey of neurointerventional physicians has suggested increasing procedural volumes, with many reporting increasing indications for patient selection since the publication of these trials.9 Further, studies have suggested that approximately 10,000 NT procedures were performed in the USA during the year 2015, with significant potential for increased volume in the future.10 11

The Joint Commission has recently proposed a new certification for hospitals entitled Thrombectomy-capable Stroke Center (TSC) Advanced Certification, intended as an intermediate classification between primary and comprehensive stroke centers.12 Most notably, TSC certification mandates the capacity to perform NT 24 hours a day, 7 days a week, the capability for other types of advanced imaging, and a written agreement for transfer with at least one comprehensive stroke center. The Joint Commission has requested comment on minimum NT volume requirements. Currently, the Joint Commission has suggested TSC certification eligibility requires that an institution has performed a minimum of 12 NTs during the previous year, or 24 NT over the past 2 years.12 A typical TSC would requires at least two to three experienced operators to provide the service 24/7. Thus, the present guidelines could translate to as few as four cases per year for each operator at some TSCs. A center performing such a low volume of NTs is highly unlikely to be performing any significant volume of other types of neuroendovascular procedures and, therefore, one would expect that the overall …

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