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Abstract
Introduction There is currently no published data evaluating the incidence of mechanical thrombectomy among stroke centers, the times at which they occur, or their burden on physicians that perform these procedures.
Methods Ten institutions queried their stroke databases to identify all patients undergoing emergent angiography with intent to perform thrombectomy for ELVO during a three month time period (June 1st, 2016 to August 31st, 2016). Data collected included origin of patient, time of initial consultation or completion of angiographic imaging, time of groin puncture, time of groin closure, and day of the week.
Results During the 92 day study period, a total of 189 patients underwent emergent angiography with intent to pursue mechanical thrombectomy for ELVO at the 10 centers. The average number of procedures per hospital over the study period was 18.9 (average of 0.2 cases per day per center). This ranged from 0.49 cases per day at the highest volume center to 0.09 cases per day at the lowest volume center. Most procedures (75%) started during daytime hours (6a-10p) with the majority of groin punctures occurring during non-work hours (59%; Figure). There was no differences in procedural frequency based on day of the week. The three-hour peak time period where most procedures were started was between 8pm and 11 pm (42 cases; 22.2% of the total). The median time from notification to groin puncture was 84 min (SEM 10.0, interquartile range 55.5–144.5) and median procedural time was 57 min (SEM 2.5, interquartile range 33–79.5 min). The average overall physician time required for each individual patient from time of notification until groin closure was just over 2.5 hours at 154 min (SEM 8.0, interquartile range 114–206.5). Time from imaging to puncture was longer during nighttime hours than during daytime (median 113 vs. 87 min; p=0.03) but procedural length did not differ based on time of day (p=0.21).
Conclusion This is the first study to quantify the time requirement of mechanical thrombectomy and the call burden on neurointerventional physicians at stroke centers. Over a three month period at 10 stroke centers across the United States, mechanical thrombectomy procedures occurred once every 5 days on average, although nearly 60% occurred during non-work hours. As ELVO awareness increases, thrombectomy call has important operational implications for hospitals implementing stroke call coverage.
Disclosures T. Wilson: None. T. Kim: None. C. Frey: None. A. Spiotta: None. R. de Leacy: None. J. Mocco: None. F. Albuquerque: None. A. Ducruet: None. A. Cheema: None. A. Arthur: None. V. Srinivasan: None. P. Kan: 2; C; Stryker; Medtronic. M. Mokin: None. T. Dumont: None. A. Rai: None. T. Leslie-Mazwi: None. J. Hirsch: None. J. Singh: None. J. Singh: None. S. Wolfe: None. K. Fargen: None.