Assessing Readiness for Acute Stroke Mechanical Thrombectomy Service

Background: Stroke is a leading cause of mortality and serious long-term disability. Recently published trials prove the superiority of endovascular mechanical thrombectomy (EMT) over best medical therapy, for selected patients with acute ischemic stroke. There is almost consensus that for optimum outcomes, onset-to-groin puncture time should be <6 h. The aim of our work is to assess our readiness to implement EMT, by evaluating aspects of delay in dealing with such time-critical group of patients. Methods: A prospective random sample of 20 patients presenting to our emergency department with acute stroke was selected. Total elapsed time from symptoms onset until release of emergency radiology report was measured and analyzed into five subcategories: from symptoms onset until decision to seek medical care (termed “awareness”); trip from home to hospital (“ambulance”); time spent in emergency room until arrival to radiology (“ER”); waiting time in radiology reception (“wait”); time until emergency radiology report release (“report”). Results: 2/20 (10%) were wake-up strokes, the other 18 cases had median time from onset to radiological diagnosis by CT, of 4:59:00. Previously described delay intervals are summarized in ascending order in this table. Median time (hours) (“ambulance” 02:17:30; “awareness”01:07:30; “ER”-00:55:00; “report”00:23:00; “wait”00:19:00; total-05:02:00). Conclusion: Assuming the interventionist reaches the hospital within 1 h, half of thrombectomy candidates can be started within the 6-h interval. There is an urgent need for mass media campaigns raising awareness regarding early manifestations of stroke. Emergency physicians should be educated about EMT, as most of them only knew about medical thrombolysis, whose window is only 4.5 h. Such unawareness can lead to slow management of patients presented beyond 4.5 h. A porter must be dedicated only for the transport of acute stroke patients. Radiology reception staff should be educated about the emergent nature of acute stroke-related scans and prioritize accordingly.

Publication History

Article published online:
11 May 2021