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Objectives: This study analyzed the learning curve effect when a new stroke thrombectomy program was initiated in a cardiac cath lab in close cooperation with neurologists and radiologists., Background: Mechanical thrombectomy has proven to be the best treatment option for ischemic stroke patients, but this method is not widely available., Methods: An endovascular treatment program for acute ischemic strokes was established in the cardiac cath lab of a tertiary university hospital in 2012. The decision to perform catheter-based thrombectomy was made by a neurologist and was based on acute stroke clinical symptoms and computed tomography angiographic findings. Patients with a large vessel occlusion of either anterior or posterior circulation were enrolled. The primary endpoint was the functional neurological outcome (Modified Rankin Scale [mRS] score) of the patient at 3 months. A total of 333 patients were enrolled between October 2012 and December 2019., Results: The clinical (mRS) outcomes did not vary significantly across years 2012 to 2019 (mRS 0 to 2 was achieved in 47.9% of patients). Symptomatic intracerebral hemorrhage occurred in 19 patients (5.7%). Embolization in a new vascular territory occurred in 6 patients (1.8%)., Conclusions: When a catheter-based thrombectomy program was initiated in an experienced cardiac cath lab in close cooperation between cardiologists, neurologists, and radiologists, outcomes were comparable to those of neuroradiology centers. The desired clinical results were achieved from the onset of the program, without any signs of a learning curve effect. These findings support the potential role of interventional cardiac cath labs in the treatment of acute stroke in regions where this therapy is not readily available due to the lack of neurointerventionalists., Competing Interests: Funding Support and Author Disclosures This paper was supported by Charles University Research program UNCE/MED/002. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Catheter-based (endovascular) thrombectomy is class I.A indication for the treatment of acute ischemic stroke. However, its availability in most countries is extremely low due to the lack of trained staff. Even the countries with best stroke services (e.g. Czech Republic) currently treat only one third of patients, who would be indicated to such therapy and in many countries the treatment simply is not available. It is estimated, that on the European level only 10% of the suitable patients are currently treated. This review manuscript is written by representatives of the three main specializations dealing with acute ischemic stroke treatment and prevention: a neurologist, a radiologist and a cardiologist. The aim is to demonstrate, that only close interdisciplinary cooperation may improve the outcomes of this devastating disease.

Acute ischemic stroke is a catastrophic cardiovascular disease with frequent cardiac causes and cerebral consequences, thus the close cooperation between neurologists and cardiologists is necessary for the optimal patient management. Furthermore, recent randomized trials demonstrated, that catheter-based thrombectomy (CBT) is the most effective treatment for properly selected patients. Interventional cardiology with its widespread non-stop services for acute myocardial infarction can fill the existing gaps in coverage of population needs with neurointerventional services. Thus, a new future medical subspecialization may emerge: neurocardiology or cardioneurology.

Acute ischemic stroke is a frequent cause of death and disability. Therepautic scepticism persists both among doctors and lay people. However, modern reperfusion therapy improved outcomes of acute stroke patients - at least of those presenting early after symptom onset. This review presents multidisciplinary approach to acute stroke - cooperation of neurologists, cardiologists and radiologists. Both reperfusion strategies are discussed: catheter-based thrombectomy and thrombolysis.

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