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. 2021 May-Aug;9(2):175-177.
doi: 10.4103/sjmms.sjmms_119_20. Epub 2021 Apr 29.

"Thrombectomy and Back:" A Novel Approach for Treating Patients with Large Vessel Occlusion in the Eastern Province of Saudi Arabia

Hosam Al-Jehani  1   2 , May Adel AlHamid  3 , Kawthar Hudhiah  3 , Aisha Al-Bakr  3 , Reem Bunayan  4 , Faisal AlAbbas  1
Affiliations

"Thrombectomy and Back:" A Novel Approach for Treating Patients with Large Vessel Occlusion in the Eastern Province of Saudi Arabia

Hosam Al-Jehani et al. Saudi J Med Med Sci. 2021 May-Aug.

Abstract

Background: Timely access to comprehensive stroke centers for patients suffering from acute ischemic stroke due to large vessel occlusion (LVO) remains a commonly encountered obstacle worldwide, especially in areas with no comprehensive stroke or thrombectomy-capable stroke centers.

Objective: To present our novel experience with a "thrombectomy-and-back" model implemented in the Eastern Province of Saudi Arabia.

Methods: King Fahd Hospital of the University (KFHU), a 600-bed hospital located in Al Khobar with an open-access emergency department, was designated as a comprehensive stroke center in the Eastern Province. "Thrombectomy-and-back" was designed such that the neurologist in the referring hospital directly communicates with the attending neurovascular team at KFHU for their anticipation of the case, and subsequently confirms LVO presence through urgent acquisition of a CT and a CT angiogram. Once LVO was confirmed, the patients were timely transferred to KFHU for mechanical thrombectomy. Upon procedure completion, the patients returned to the referring hospital with the same medical and EMS team. The safety of transfer and peri-procedural complications were analyzed.

Results: From December 2017 to December 2019, 20 thrombectomy-and-back codes were activated, of which 10 were deactivated on negative LVO and 10 remained activated. Of these 10 patients, 2 required admission to our hospital's Neuro-ICU: one was because the middle cerebral artery reoccluded during the procedure and the other was due to hemodynamic instability upon arrival; this first patient passed away 2 months later due to the complications of the malignant left middle cerebral artery stroke.

Conclusions: The novel Thrombectomy-and-Back model in the Eastern Province of Saudi Arabia has proved to be a safe and efficient approach for patients presenting with LVO to receive timely interventional therapy and minimizing futile transfers.

Keywords: Acute ischemic stroke; occlusion; tele-stroke; thrombectomy.

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Conflict of interest statement

There are no conflicts of interest.

References

    1. Adeoye O, Nyström KV, Yavagal DR, Luciano J, Nogueira RG, Zorowitz RD, et al. Recommendations for the establishment of stroke systems of care: A 2019 update a policy statement from the American Stroke Association. Stroke. 2019;50:e187–210. - PubMed
    1. Malhotra K, Gornbein J, Saver JL. Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: A review. Front Neurol. 2017;8:651. - PMC - PubMed
    1. Brandler ES, Baksh N. Emergency management of stroke in the era of mechanical thrombectomy. Clin Exp Emerg Med. 2019;6:273–87. - PMC - PubMed
    1. Jayaraman MV, Iqbal A, Silver B, Siket MS, Amedee C, McTaggart RA, et al. Developing a statewide protocol to ensure patients with suspected emergent large vessel occlusion are directly triaged in the field to a comprehensive stroke center: How we did it. J Neurointerv Surg. 2017;9:330–2. - PubMed
    1. Noorian AR, Sanossian N, Shkirkova K, Liebeskind DS, Eckstein M, Stratton SJ, et al. Los Angeles motor scale to identify large vessel occlusion: Prehospital validation and comparison with other screens. Stroke. 2018;49:565–72. - PMC - PubMed