Purpose The INterventional Stroke Therapy Outcomes Registry (INSTOR) was commissioned over a decade ago at the request of the Society of NeuroInterventional Surgery and the American Academy of Neurology Interventional Stroke Task Force in order to answer questions concerning intra-arterial fibrinolysis. INSTOR is now an open, national, error-detecting, risk-adjusting, HIPAA-compliant, computerized, web-based registry that tracks intra-hospital processes, patient and procedural risk factors, as well as angiographic and clinical outcomes for both medical (IV tPA) and endovascular stroke interventions.
Materials and Methods Online databases (registries) are currently used by numerous specialties to track processes and outcomes, including cardiology (eg, TIMI trials) and oncology. In the neurosciences, Get-With-The-Guidelines/Stroke is the most commonly used registry/database but does not track emergency processes, angiographic results or 90-day clinical outcomes for either IV tPA or emergency endovascular therapy. In order to achieve far more complex real-time analysis and data output, INSTOR has been completely reprogrammed on a far more comprehensive computer database platform utilizing point and click data entry and automatic error detection. Further, since there is no national clinical outcomes database for IV tPA in the US as exists in Europe (SITS-MOST), INSTOR was redesigned to be used as the single registry for both hospital processes as well as clinical outcomes for all forms of emergency stroke treatment, including IV tPA.
Results INSTOR is now capable of providing real-time on-screen feedback on numerous points necessary for process improvement as well as monitoring overall hospital performance and clinical outcomes. INSTOR can provide real-time comparison of numerous data points of a medical institution's performance vs an anonymous national aggregate. Data entry typically requires 5–10 min for each stroke alert, 10 min for all aspects of an IV tPA case, and 30 min for all aspects of an intra-arterial/endovascular stroke case. The data output includes graphical representation of min/median/max with trends for real-time data points such as: door to CT, door to IV tPA, door to puncture, door to treatment, 90-day mRS for IV tPA, 90-day mRS for endovascular treatment, 90-day outcomes for combination IV tPA plus endovascular treatment, initial and final angiographic reperfusion scores, and numerous clinical comorbidities and demographics. INSTOR can determine outcomes of stroke treatments based upon time to treatment, time to reperfusion, and specific clot locations as well as CT/MR perfusion or imaging characteristics.
Conclusion There is a lack of accurate data concerning clinical outcomes of endovascular or IV treatment of stroke in the USA. There is a need for continual process improvement for all aspects of stroke care and ongoing quality assurance for institutions performing stroke treatment of all kinds. All neuroscience societies and organizations, including Society of NeuroInterventional Surgery and SVIN, have mandated the use of a national registry for tracking clinical outcomes. INSTOR is unique in the ability to track clinical outcomes and foster improvement in processes of care throughout the chain of care for emergency stroke treatment.
Competing interests None.
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