Performance and quality metrics for recanalization therapy

David Goldemund M.D.
Updated on 19/09/2024, published on 19/09/2024

performance and quality metrics help monitor the effectiveness, safety, and overall quality of stroke care
continuous evaluation of care helps ensure the best possible outcome for patients undergoing reperfusion therapies
here are key performance and quality metrics

90-day functional outcome – proportion of patients with a modified Rankin Scale (mRS) score of 0-2 (good functional outcome) at 90 days post-treatment
mortality rate (in-hospital or 90-day)
proportion of patients discharged to home or rehabilitation facilities or long-term care)
early neurological improvement (decrease in NIHSS)
- a significant reduction in NIHSS score within 24 hours indicates effective recanalization

percentage of recanalization with partial or complete distal reperfusion (TICI 2b/3) → Angiographic grading of revascularization therapy
recanalization during IVT can be monitored via TCD/TCCD → TIBI criteria
- do not wait for the effect of IVT in patients eligible for thrombectomy!

adherence to stroke protocols
incidence of bleeding
- hemorrhagic transformation of ischemia, particularly symptomatic ICH (sICH) (ideally < 6%) → Hemorrhagic complications in acute stroke
- SAH (typical complication of endovascular procedures)
incidence of other periprocedural complications → Complications of endovascular procedures
- reocclusion
- dissection
- device-related complications
- distal embolization
- anesthesia-related complications during MT (e.g., blood pressure variability, hypoxia)

several time indicators (see table) are evaluated because delays in reperfusion are associated with worse neurological recovery and increased mortality
- assess the proportion of cases where treatment times met recommended benchmarks
key components of stroke care that decrease onset-to-reperfusion time (ORT) include:
- early recognition of stroke symptoms and activation of emergency medical services (EMS)
- fast and appropriate triage
- rapid imaging and initiation of thrombolysis
- optimized endovascular workflow with minimal procedural delays
another quality indicator is the proportion of eligible patients treated (percentage of stroke patients eligible for IVT/MT who receive therapy)