International Stroke Conference
February 6–8, 2019
Robert W. Regenhardt, MD, PhD
Moderators: Carmelo Graffagnino, Edward Jauch
The first talk, “Challenges in Patient Access,” by Carmelo Graffagnino discussed the system problems we face in the thrombectomy era. There are many system models that can be used to organize a region for the care of acute stroke patients. The models that worked well in the past allowed rapid access to tPA, but as thrombectomy expertise is a scarcer resource, there are new challenges. Graffagnino described two cases: one that showed how the system can work perfectly and another that highlighted limitations as a patient experienced severe delay in transferring to the thrombectomy capable center. Some of these limitations are difficult to predict and even more difficult to fix from the perspective of physicians, such as lack of helicopter and ambulance availability.