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Ischemic stroke
Original research
A multicenter study evaluating the frequency and time requirement of mechanical thrombectomy
  1. Taylor A Wilson1,
  2. Thabele Leslie-Mazwi2,
  3. Joshua A Hirsch2,
  4. Casey Frey1,
  5. Teddy E Kim1,
  6. Alejandro M Spiotta3,
  7. Reade de Leacy4,
  8. J Mocco4,
  9. Felipe C Albuquerque5,
  10. Andrew F Ducruet5,
  11. Ahmed Cheema6,
  12. Adam Arthur6,
  13. Visish M Srinivasan7,
  14. Peter Kan7,
  15. Maxim Mokin8,
  16. Travis Dumont9,
  17. Ansaar Rai10,
  18. Jasmeet Singh1,
  19. Stacey Q Wolfe1,
  20. Kyle M Fargen1
  1. 1 Department of Neurological Surgery, Wake Forest University, Winston-Salem, NC, USA
  2. 2 Department of Interventional Neuroradiology, Massachusetts General Hospital, Boston, MA, USA
  3. 3 Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
  4. 4 Department of Neurosurgery, Mount Sinai Hospital, New York, NY, USA
  5. 5 Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA
  6. 6 Department of Neurosurgery, University of Tennessee/Semmes-Murphy Clinic, Memphis, TN, USA
  7. 7 Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
  8. 8 Department of Neurosurgery, University of South Florida, Tampa, FL, USA
  9. 9 Department of Neurosurgery, University of Arizona, Tucson, AZ, USA
  10. 10 Department of Radiology, West Virginia University, Morgantown, WV, USA
  1. Correspondence to Dr Kyle M Fargen, Department of Neurological Surgery, Wake Forest University, Winston-Salem, NC 27125, USA; kfargen{at}wakehealth.edu

Abstract

Introduction There are few published data evaluating the incidence of mechanical thrombectomy among stroke centers or the times at which they occur.

Methods A multicenter retrospective study was performed to identify all patients undergoing emergent thrombectomy for acute ischemic stroke during a 3-month period (June through August 2016). Consultations that did not undergo thrombectomy were not included.

Results Ten institutions participated in the study. During the 92-day study period, a total of 189 patients underwent mechanical thrombectomy. The average number of procedures per hospital over the study period was 18.9 (average of 0.2 cases per day per or 75.6 cases per year). This ranged from 0.09 cases per day at the lowest volume center to 0.49 cases per day at the highest volume center. Procedures were more common on weekdays (p<0.001) and during non-work hours (p<0.001). The most common period for thrombectomy procedures was between 20:00 and 21:00 hours. The median time from notification to groin puncture was 84 min (IQR 56–145 min) and from puncture to closure was 57 min (IQR 33–80 min). The median time from imaging completion to procedural start was 52 min longer for non-work hours than during work hours (p<0.001). There were no differences in procedural length based on day of the week or time of day.

Conclusions These findings indicate that the majority of mechanical thrombectomy cases occur during non-work hours, with associated off-hours delays, which has important operational implications for hospitals implementing stroke call coverage.

  • Mechanical thrombectomy
  • Incidence
  • Acute ischemic stroke
  • Time

https://doi.org/10.1136/neurintsurg-2017-013147

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    Footnotes

    • Contributor Conception and design: KF. Data collection and interpretation: All authors. Statistical analysis: TW. Drafting the article: TW, TL, JH, KF. Critical revision of article: All authors. Final approval of article: All authors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.