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Original research
Strategies to reduce the impact of demand for concurrent endovascular thrombectomy
  1. Ankur K Dalsania1,
  2. Akash P Kansagra2,3,4
  1. 1 Rutgers New Jersey Medical School, Newark, New Jersey, USA
  2. 2 Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri, USA
  3. 3 Department of Neurological Surgery, Washington University School of Medicine, St Louis, Missouri, USA
  4. 4 Department of Neurology, Washington University School of Medicine, St Louis, Missouri, USA
  1. Correspondence to Dr Akash P Kansagra, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO 63110, USA; apkansagra{at}


Background The rise in demand for endovascular thrombectomy (EVT) has increased the possibility that multiple patients with acute ischemic stroke may present concurrently and exceed local capacity to provide timely treatment. In this work, we quantitatively compared the efficacy of various strategies to mitigate demand in excess of capacity (DEC).

Methods Strategies evaluated included a backup neurointerventional team for 3 hours, 8 hours, or 24 hours per day; a separate pre-intervention imaging team; and a 30% decrease in procedure duration. For each strategy, empirical distributions were used to probabilistically generate arrival time and case duration for 16 000 independent trials repeated across a range of annual case volumes. DEC was calculated from time series representing the number of concurrent cases at each minute of the year for each trial at each case volume.

Results All strategies decreased DEC compared with baseline. At a representative volume of 250 cases per year, availability of a backup team for 3 hours, 8 hours, and 24 hours per day reduced DEC by 27.0%, 60.3%, and 97.2%, respectively, compared with baseline. Similarly, availability of a pre-intervention imaging team and a 30% decrease in procedure duration reduced DEC by 26.6% and 17.7%, respectively, compared with baseline.

Conclusions A backup neurointerventional team, even if available only part time, was an effective strategy for decreasing DEC for EVT. Understanding the actual quantitative benefit of each strategy can facilitate rational cost–benefit analyses underlying the development of efficient and sustainable models of care.

  • thrombectomy
  • stroke
  • economics

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  • Contributors APK conceived, designed, and supervised the study. APK and AKD created the simulation and analyzed the data. AKD prepared the first draft. AKD and APK revised the manuscript and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The local institutional review board approved retrospective review of the institutional endovascular thrombectomy data.

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

  • Data availability statement The deidentified participant data that support the findings of this study are available from the corresponding author upon reasonable request.