Interdisciplinary Rendez-Vous Approach in Endovascular Stroke Treatment: A New Concept to Accelerate Mechanical Thrombectomy in Primary Stroke Centers

Abstract

Abstract Purpose Prompt endovascular treatment of patients with stroke due to intracranial Large Vessel Occlusion (LVO) is a major challenge in rural areas because neurointerventionalists are usually not available. As a result, treatment is delayed, and clinical outcomes are worse compared with patients primarily treated in comprehensive stroke centers (CSC). To address this problem, we present a concept in which interdisciplinary, on-site endovascular treatment is performed in a Primary Stroke Center (PSC) by a team of interventional neuroradiologists and cardiologists: the Rendez-Vous approach. Methods Thirty-five patients with LVO who underwent interdisciplinary thrombectomy on-site at the PSC as part of the Rendez-Vous concept were compared with 72 patients who were transferred from a PSCs to the CSC for thrombectomy when diagnosed with LVO in terms of temporal sequences and clinical outcomes. Results Patients treated on-site at the PSC as part of the Rendez-Vous approach were managed as successfully and without an increase in complication rates compared with patients treated secondarily at a CSC (91.7% successful interventions in Rendez-Vous vs. 87.3% in control group, p = 0.57). The time from diagnosis of LVO to groin puncture was reduced by mean 74.3 min with the Rendez-Vous concept (p < 0.01). Regarding the clinical outcome, a functionally independent status was achieved in 45.5% in the Rendez-Vous group and in 22.6% in the control group (p = 0.029). Conclusion Thanks to interdisciplinary teamwork between cardiology and interventional neuroradiology in local PSCs, times to successful reperfusion can be reduced. This has a potentially positive impact on the clinical outcome of stroke patients. Graphical Abstract