Procedural Requirements and Certification Paradigms for Stroke Care Delivery: Perspective of Neurointerventional Professional Societies

Approximately 795 000 strokes occur annually in the United States, and stroke remains a leading cause of major disability.1 Ischemic stroke accounts for ≈85% of cases, whereas the remaining 15% are attributable to hemorrhagic pathogeneses. Despite increased public awareness, improved prehospital triage and a greater focus on systems of care, intravenous tissue-type plasminogen activator, and endovascular intervention remain underutilized.2 Recent advances in endovascular technology, coupled with the positive results of at least 5 major clinical trials, support the efficacy of mechanical thrombectomy as a treatment of ischemic stroke.3–6 These studies emphasize that interventional capabilities are an essential element of stroke care. Before the completion of these interventional trials, several simultaneous efforts arose to provide a method of certifying institutions as being optimized for advanced cerebrovascular care, and these efforts were inclusive of ischemic and hemorrhagic disease. It is in the spirit of constant iterative improvement that the authors of this article call for a refinement of the requirements for the certification of hospitals as comprehensive stroke centers (CSCs). The certification process has the potential to serve an important function in improving the quality of care and patient outcomes by establishing criteria for certification of stroke centers. The Cerebrovascular Coalition (CVC), which represents all neuroscience-based physician professional societies in the United States (CVC member organizations include the American Academy of Neurology, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Society of Vascular and Interventional Neurology, American Society of Neuroradiology, and the Society of NeuroInterventional Surgery) involved in the care of patients with acute stroke, embraces and applauds the need for greater access to acute stroke therapy. The CVC thinks that, in principle, a certification process for stroke centers can have a positive impact on patient care and outcomes. The Joint Commission (TJC), in partnership with the …