OBJECTIVE: To report our initial experience in setting up a neuroendovascular service in a university-based comprehensive stroke center. METHODS: We determined the rates of referral path, procedural type, and independently adjudicated 1-month outcomes (actual rates) in first 150 procedures (120 patients) and subsequently compared with rates derived from pertinent clinical trials after adjustment for procedural type (predicted rates). RESULTS: The patients were referred from the emergency department (n= 44), transferred from another hospital (n= 13), or admitted for elective procedures from the clinic (n= 63). The procedures included treatment of acute ischemic stroke (n= 12); extracranial carotid stent placement (n= 33); extracranial vertebral artery stent placement (n= 13); intracranial angioplasty and/or stent placement (n= 12); embolization for intracranial aneurysms (n= 35), arteriovenous malformations (n= 5), and tumors (n= 10); cerebral vasospasm treatment (n= 26); and others (n= 4). The technical success rate was 100% for intracranial aneurysm obliteration and extracranial carotid artery stent placement, and 95% for those undergoing intracranial or vertebral artery stent placements; and partial or complete recanalization was achieved in 72% of patients undergoing intra-arterial thrombolysis. After adjusting for procedural type, the actual adverse event rate of 3% compared favorably with the predicted rate of 7% based on the results of clinical trials. CONCLUSIONS: We provide estimates of procedure volumes and outcomes observed in the initial phase of setting up a neuroendovascular service with an active training program.
Hemostatic Techniques , Hospital Units/organization & administration , Outcome and Process Assessment, Health Care , Stents , Stroke/therapy , Vascular Surgical Procedures , Adolescent , Adult , Aged , Female , Hospitals, University , Humans , Male , Middle Aged , Minnesota , Organizational Objectives , Referral and Consultation/statistics & numerical data
BACKGROUND: Stroke can advesely affect movements, sensations, alertness, awareness, coordination, and judgement, all of which may impair the ability to drive a car. DISCUSSION: Many stroke patients consider driving to be essential to their quality of life and want to drive if at all possible. Thus, the physician may be challenged with a tough decision about whether a patient should be allowed to drive. CONCLUSION: Referral to an occupational therapist can be of great help.
BACKGROUND: Fatigue is a common complaint after a stroke, and contributes to the large national burden of caring for stroke victims. Nevertheless, causes and cures for post-stroke fatigue are generally under-appreciated. DISCUSSION: Post-stroke fatigue can be organic, psychological, emotional, or a combination of these. A precise diagnosis will aid in treatment planning for effective return to normal levels of activity. Depending on the cause of fatigue, a post-stroke patient may benefit from physical therapy, occupational therapy, anti-depressants, counseling, and careful attention to basic needs. However, patients and care-givers should be patient and recognize that a stroke victims may never fully recover their abilities and dealing with fatigue may be a long-term issue. CONCLUSION: Post-stroke fatigue can be vexing but multi-modal rehabilitation often allows at least some improvement. Additional research on effective therapy for different sources of fatigue will benefit our stroke patients in the future.
