The "Neurovascular Net Ruhr" Concept and Implementation of a Transregional Network to Optimize Neurovascular Treatment of Acute Stroke Patients in the Ruhr District

Background: Thrombolysis with rt-PA and stroke unit treatment are the only evidence-based therapies for acute ischaemic stroke patients. However, several studies show a regional variability in rates of thrombolysis and an overall potential for improvcement. Mechanical recanalisation is a promising therapeutic option, but no randomised trials have yet proven its efficacy. To optimise the comprehensive neurovascular treatment of acute stroke patients, the Neurovascular Net Ruhr" was initiated as one of several networks in Germany. Methods: A presentation is given of systematic activities in the implementation of a transregional neurovascular network to improve acute stroke care treatment and to provide specific neurointerventional treatment options. Results: Four components in the network concept are identified and presented: (i) cooperation of neurological and interventional-neuroradiological departments in the Ruhr district; (ii) development of common quality standards in terms of treatment manuals and transregional allocation concept for neurointerventional therapy; (iii) cross-linking of radiological diagnostic systems to facilitate real-time peer-to-peer file sharing; (iv) development of a data bank for quality assurance of procedural treatment information and long-term outcome. Discussion: Several approaches in acute stroke treatment currently try to increase the rate of systemic thrombolysis and investigate the potential benefit of neurointerventional therapies. Besides the establishment of neurovascular centres offering acute stroke treatment including mechanical revascularisation, networks are being established to increase specific stroke treatment and improve patient transferals. Patient-centred care structures in the Ruhr area provide an exemplary cooperation through standardised workflows and area-wide and continuous provision of interventional therapies. Implementation and outcome quality will be analysed by a region-wide prospective data bank.