In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after...

Area of Science:

• Interventional Radiology
• Neuroendovascular Surgery
• Stroke Medicine

Background:

• Previous research indicates delayed treatment negatively impacts stroke patient outcomes.
• Mechanical thrombectomy (MT) is a critical intervention for acute ischemic stroke.

Purpose of the Study:

• To assess the effect of presentation time on MT metrics.
• To determine the association between time of presentation and long-term functional outcomes in an OR setting.

Main Methods:

• Retrospective analysis of 315 stroke patients undergoing MT (Jan 2015-Dec 2018).
• Comparison of outcomes between 'after-hours' (evenings, nights, weekends, holidays) and 'work hours' (weekdays 7 AM-5 PM).
• Primary outcome: 90-day modified Rankin Scale (mRS); Secondary outcomes: door-to-groin time, complications.

Main Results:

• 66.4% of MT procedures were performed after hours.
• No significant difference in 90-day mRS or functional independence (mRS 0-2) between after-hours and work hours groups.
• Door-to-groin times and procedural complication rates were similar between groups.

Conclusions:

• Mechanical thrombectomy during off-hours yielded comparable functional outcomes to procedures during work hours.
• The potential negative impact of after-hours treatment may be mitigated by 24-hour availability of anesthesia and IR technical support.