Mechanical thrombectomy: the Wessex Model – reflections and future challenges

Marigold, Richard, Weir, N., Crawford, P., Evans, S., Battersby Wood, Emma, Lovett, J., Macdonald, J.H.M., Millar, J., Williams, A.J. and Ditchfield, A. (2018) Mechanical thrombectomy: the Wessex Model – reflections and future challenges. 2018 UK Stroke Forum, , Telford, United Kingdom. 04 - 06 Dec 2018. p. 108 . (doi:10.1177/1747493018801108).

Abstract

Introduction: Mechanical thrombectomy is an endovascular intervention that significantly improves neurological outcomes in patients with cerebral large vessel occlusion. University Hospital Southampton (UHS) serves a regional population of 2.8 million people and 8 district general hospitals in a mix of urban and rural settings. As a consequence, a “drip and ship” model has been established in which patients receive intravenous thrombolysis en route to thrombectomy
Methods: Between June 2016 and June 2018, 56 patients have undergone thrombectomy treatment, of whom 33 were transferred from other hospitals. We review the outcomes and plans for future service development.
Results: 56 patients were transferred for thrombectomy. 51/56 had a CT angiogram, 37 received thrombolysis. Mean NIHSS 17.3 pre-thrombectomy, falling to 5.09 at 48 hours post procedure. 35/56 (62%) had either partial or complete recanalisation. 12 patients (21%) died within the first week.
Mean time from symptom onset to referral was 1 hour 46 minutes, and transfer time from referral to arrival at UHS was 1 hour 30 minutes. Arrival to groin puncture averaged 36 min.
Conclusion: Initial experience with developing thrombectomy in Wessex via a drip and ship model shows that it has improved patient outcomes both in terms of recanalisation and a reduction in NIHSS score and subsequent disability. Future challenges include raising awareness of eligible patients across secondary care to reduce referral times and improving the transfer pathway to expedite groin puncture.

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