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Table of Contents    
LETTER TO EDITOR
Year : 2020  |  Volume : 68  |  Issue : 6  |  Page : 1484-1485

The “HIS and HER Cart”—Solution to Pandora's Box in Acute Ischemic Stroke Intervention


1 DM Neuroimaging and Interventional Neuro-Radiology, Consultant Diagnostic and Interventional Neuro-Radiologist, Apollo Hospital, Bengaluru, Karnataka, India
2 Department of Imaging Sciences and Interventional Radiology, DM Neuroimaging and Interventional Neuro-Radiology, KMCH, Coimbatore, Tamil Nadu, India

Date of Web Publication19-Dec-2020

Correspondence Address:
Dr. Shriram Varadharajan
Department of Imaging Sciences and Interventional Radiology, KMCH, Coimbatore - 641014, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.304123

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How to cite this article:
Kumar SG, Varadharajan S. The “HIS and HER Cart”—Solution to Pandora's Box in Acute Ischemic Stroke Intervention. Neurol India 2020;68:1484-5

How to cite this URL:
Kumar SG, Varadharajan S. The “HIS and HER Cart”—Solution to Pandora's Box in Acute Ischemic Stroke Intervention. Neurol India [serial online] 2020 [cited 2021 Jan 24];68:1484-5. Available from: https://www.neurologyindia.com/text.asp?2020/68/6/1484/304123




Sir,

“Great things are not done by impulse, but by a series of small things brought together”

Vincent Van Gogh

Endovascular treatment has become standard of care in acute ischemic stroke with proximal large vessel occlusions.[1] Key to the success is the concept of “Time is brain” and in this case recanalization as fast as possible.

Most of the emergency calls of acute stroke happen during odd hours or on holidays. Ordering emergency imaging, obtaining informed consent, and organizing allied technical staff for the procedure including anesthesia takes its own time. In Indian set up, the additional financial burden on the patient's family is huge and expectations are very high and hence achieving the goal of fast recanalization requires dedicated teamwork and pre-organization of the entire setup.

Hence, all efforts should be made to reduce the door to recanalization time by facilitating this process. One important step toward achieving this is to have “ready to go hyperacute ischemic stroke (HIS) and handy endovascular retrieval (HER) cart” [Figure 1] in the catheterization (cath) lab. Various consensus guidelines have already spoken about the need to have a recanalization kit ready in the cath lab.[2],[3]Some institutions even prefer to keep all necessary hardware opened and ready for use except for stent.
Figure 1: Hyperacute ischemic stroke (HIS) and handy endovascular retrieval (HER) cart prototype example—Having wheels and facility to hang long catheters at back while other materials are stacked inside

Click here to view


The additional modifiable challenge here is the pre-organization of the required materials since the cath lab is often common for cardiologists, general radiology, and vascular surgeons. Hence, dedicated materials required for mechanical thrombectomy may not be readily available. This can be overcome by HIS and HER cart.

The cart basically contains all the necessary materials stored in one box with a trolley. All diagnostic catheters, guiding catheters, and long sheaths are in open vertical storage at the back and necessary microcatheters, microwires, stent retrievers, aspiration tubes, Y connectors, snares, and emergency coils are in the main closed central compartments. While a patient is being draped, the interventionist can review images, analyze vascular anatomy and have a mental roadmap for catheter access specific to that patient thereby asking staff to pull out those catheters and be ready by the time a puncture is being made.

This is similar to the STEMI box[4] to shorten door to balloon time in cardiology lab which has been proven effective to save time in an emergency. The cart can be custom made similar to the one shown in the picture below made up of tough polycarbonate body with wheels. This can be rolled around various cath labs in the hospital in big setups with multiple sites of stroke intervention.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Among author contributions in the cover letter, the following acknowledgement was given.

Special Acknowledgment

Dr Venkatesh Aiyagari,

University of Texas Southwestern Medical Center.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Powers WJ, Derdeyn CP, Biller J, Coffey CS, Hoh BL, Jauch EC, et al. 2015 American heart association/American stroke association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: A guideline for healthcare professionals from the American heart association/American stroke association. Stroke 2015;46:3020-35.  Back to cited text no. 1
    
2.
Frei D, McGraw C, McCarthy K, Whaley M, Bellon RJ, Loy D, et al. A standardized neurointerventional thrombectomy protocol leads to faster recanalization times. J Neurointerv Surg 2017;9:1035-40.  Back to cited text no. 2
    
3.
Kim D-H, Kim B, Jung C, Nam HS, Lee JS, Kim JW, et al. Consensus statements by Korean society of interventional neuroradiology and Korean stroke society: Hyperacute endovascular treatment workflow to reduce door-to-reperfusion time. Korean J Radiol 2018;19:838-48.  Back to cited text no. 3
    
4.
Bradley Elizabeth H, Curry Leslie A, Webster Tashonna R, Mattera Jennifer A, Roumanis Sarah A, Radford Martha J, et al. Achieving rapid door-to-balloon times. Circulation 2006;113:1079-85.  Back to cited text no. 4
    


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