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Original research
Real-world effects of late window neurothrombectomy: procedure rates increase without night-time bias
  1. Michelle Marie Williams1,
  2. Thabele Leslie-Mazwi2,
  3. Joshua A Hirsch2,
  4. Carol Kittel1,
  5. Alejandro Spiotta3,
  6. Reade De Leacy4,
  7. J Mocco4,
  8. Felipe C Albuquerque5,
  9. Andrew F Ducruet5,
  10. Nitin Goyal6,
  11. Adam S Arthur7,
  12. Peter Kan8,
  13. Maxim Mokin9,
  14. Travis M Dumont10,
  15. Alan Reeves11,
  16. Stacey Q Wolfe1,
  17. Kyle Fargen1
  1. 1Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
  2. 2Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  4. 4Neurosurgery, Mount Sinai Hospital, New York City, New York, USA
  5. 5Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  6. 6Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee, USA
  7. 7UT Dept Neurosurgery/Semmes-Murphey Clinic, Memphis, Tennessee, USA
  8. 8Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  9. 9Neurosurgery, University of South Florida, Tampa, Florida, USA
  10. 10Neurosurgery, University of Arizona/Arizona Health Science Center, Tucson, Arizona, USA
  11. 11Neuroendovascular Division, Department of Radiology, University of Kansas Medical Center, Kansas City, Kansas, USA
  1. Correspondence to Dr Michelle Marie Williams, Neurological Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27103, USA; williamsm0912{at}gmail.com

Abstract

Introduction With the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures.

Methods Neurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24-hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017.

Results Data were collected from a total of 300 days of call. A total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24-hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87% of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37% between the hours of 16:00 and 20:00.

Conclusions MT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. Compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams.

  • stroke
  • thrombectomy
  • angiography
  • intervention
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Footnotes

  • Twitter @JoshuaAHirsch, @rdeleacymd, @AdamArthurMD

  • Correction notice Since this paper was published online first, middle initials have been added to Dr Ducruet and Dr Albuquerque names.

  • Contributors Conception and design: KF. Data collection and interpretation: all authors. Statistical analysis: CK. Drafting the article: MMW, KF. Critical revision of article: all authors. Final approval of article: all authors.

  • 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.

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

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