Brainstorming Solutions

To keep up with recent advancements in neurovascular care, HealthTrust has expanded its category of products to treat neurovascular conditions. These include devices used for acute ischemic stroke and hemorrhagic stroke, as well as neurovascular access devices and accessories.

The use of mechanical thrombectomy

Stroke treatment technology has improved significantly over the last few years. Perhaps the most noteworthy development is with mechanical thrombectomy techniques and approaches for acute ischemic stroke, the most common type of stroke.

For years, physicians have been relying on tissue plasminogen activator (tPA), a thrombolytic drug that acts to dissolve a blood clot in the brain. While this treatment can be lifesaving, its effectiveness is limited because it must be administered within a three-hour window, and stroke patients aren’t always able to get to the hospital in time.

“tPA is still the treatment, but advanced healthcare centers are doing thrombectomy, which actually extracts the clot by snaring it with a stent or suctioning it out,” explains Dan Ingram, AVP of Custom Contracting for Trinity Health. This treatment is performed much more rapidly than a clot buster. And because the mantra for stroke treatment is “time is brain,” the faster the treatment, the more positive the outcome.

Mechanical thrombectomy, used primarily for large-vessel occlusion stroke, has also proven to be quite effective. Interventional physicians use revascularization devices such as stent retrievers, aspiration catheters and pumps to remove a clot from a patient with impressive speed and precision.

While not every stroke can be treated with mechanical thrombectomy, acute ischemic strokes with large-vessel occlusion are treated with this procedure, and studies have demonstrated high success rates. “The number needed to treat for stroke is very low, at 2.6. If you treat almost three stroke patients with mechanical thrombectomy, at least one individual will benefit, which is a really impressive number,” says Karen Bush, MSN, FNP, BC, NCRP, Director of Clinical Research and Education for Clinical Services at HealthTrust.

In 2018, Trinity Health’s Saint Joseph Mercy Health System in Michigan was the first hospital in the nation to receive certification from The Joint Commission as a Thrombectomy-Capable Comprehensive Stroke Center. “The Joint Commission is helping to advance stroke care and ensure hospitals are capable,” says Ingram.

Quality improvements to devices & approaches

The major device suppliers continue to innovate and offer new products with smaller catheters and other advancements that allow them to reach smaller vessels in the brain to remove a clot. Mechanical thrombectomy procedures using aspiration catheters, stent retrievers or a combination of the two with or without a balloon guide catheter have been developed in an attempt to improve patient outcomes.

The goal is to improve blood flow to the brain as quickly as possible, resulting in improved neurologic function for the patient.

Low first-pass rates are preferred, which means the physician is successful at retrieving the clot on the first attempt. “This causes less trauma to the vessel and is faster and better for the patient,” explains Bush.

In addition, more interventional physicians are considering use of a radial artery access approach, which means going in through the wrist rather than the groin. This shift was made years ago in interventional cardiology and is now used routinely.

“Interventional neurology has seen increased interest in this alternative access approach for the same reasons it is used in interventional cardiology. Reasons include reduced complication rates, including bleeding; reduced hospital length of stay; and improved patient satisfaction with the procedure,” says Bush. More research is needed, but early studies show stroke patients appear to respond well to the radial technique.

In the treatment of ruptured and unruptured aneurysms, products and approaches have also evolved. Physicians can use a tiny coil to fill an aneurysm, blocking flow and preventing rupture. A balloon assist technique and intracranial stents can be used as adjuncts to the procedure. There are also flow diversion devices that reduce the risk of aneurysm rupture by routing flow back on the normal vessel path and away from the aneurysm. Flow diverters have been widely adopted in the treatment of unruptured intracranial aneurysms.

Contracts to accommodate physician preferences

Physician preference and training is a strong factor in the selection of devices in this category. Engaging physicians who perform these procedures in your organization is key in your value analysis process.

Such is the case at Trinity Health, a healthcare network that spans across 22 states from coast to coast, says Ingram. At the local hospital level, there are value analysis teams that approve products for stroke teams to use.

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