Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 1;20(1):326.
doi: 10.1186/s12883-020-01909-8.

Mechanical thrombectomy: can it be safely delivered out of hours in the UK?

Jake Weddell  1 , Emma Parr  2 , Stacey Knight  3 , Girish Muddegowda  2 , Indira Natarajan  2 , Jayan Chembala  2 , Phillip Ferdinand  2 , Nasar Ahmad  2 , Zoltan Pencz  2 , Saad Rana  2 , Anushka Warusevitane  2 , Changez Jadun  4 , Sanjeev Nayak  4 , Zafar Hashim  4 , Albin Augustine  5 , Julius Sim  3 , Christine Roffe  2   3
Affiliations

Mechanical thrombectomy: can it be safely delivered out of hours in the UK?

Jake Weddell et al. BMC Neurol. .

Abstract

Background: Mechanical thrombectomy was approved by NICE as a treatment for stroke in 2016. However, most of the evidence is from studies conducted during working hours. Only few centres in the UK perform thrombectomies out-of-hours. The Royal Stoke University Hospital (RSUH) has offered thrombectomies over 24 h (24/7) since 2010. The aim of this service review is to compare the outcomes for patients treated in regular working hours to those treated outside normal working hours within this unit.

Methods: This retrospective service analysis includes all patients treated with mechanical thrombectomy at RSUH since the start of the service in January 2010 to June 2019. Data on key demographics, timings, procedural complications, and long-term outcomes including death and disability at 90 days were collected. In-hours was defined as the time between 8:00-17:00 h, Monday to Friday; out-of-hours was defined as any time outside this period.

Results: In total, 516 mechanical thrombectomies were performed in this time period; data were available on 501 of these. Successful recanalization (TICI 2b/3) was achieved in 86% of patients. By 90 days 96 (19%) had died and 234 (47%) were functionally independent (modified Rankin Scale score ≤ 2). 211 (42%) of the procedures were performed in-hours and 290 (58%) out-of-hours. Door-to-CT and door-to-groin times were significantly longer out-of-hours than in-hours, but thrombectomy duration was significantly shorter. There were no significant differences in complications and short- and long-term outcomes.

Conclusion: Mechanical thrombectomy was delivered safely and effectively 24/7 in this UK hospital, with no difference in clinical outcomes.

Keywords: Large vessel occlusion; Mechanical thrombectomy; Stroke.

PubMed Disclaimer

Conflict of interest statement

CR has received thrombectomy devices from Medtronic for an ongoing in vitro research study. No other competing interests.

Figures

Fig. 1
Fig. 1
Flowchart showing number of patients treated in-hours vs out of hours, day vs night and weekend vs weekday
See this image and copyright information in PMC

References

    1. Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–1731. doi: 10.1016/S0140-6736(16)00163-X. - DOI - PubMed
    1. Mechanical clot retrieval for treating acute ischaemic stroke [IPG548]. The National Institute for Health and Care Excellence; 2016.
    1. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21. doi: 10.1056/NEJMoa1706442. - DOI - PubMed
    1. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–718. doi: 10.1056/NEJMoa1713973. - DOI - PMC - PubMed
    1. McMeekin P, White P, James MA, Price CI, Flynn D, Ford GA. Estimating the number of UK stroke patients eligible for endovascular thrombectomy. Eur Stroke J. 2017;2(4):319–326. doi: 10.1177/2396987317733343. - DOI - PMC - PubMed

LinkOut - more resources