To support safe provision of mechanical thrombectomy services for patients with acute ischaemic stroke: 2021 consensus guidance from BASP, BSNR, ICSWP, NACCS, and UKNG

Marigold, Richard, Mortimer, Alan, Lenthall, R., Wiggam, M. Ivan, Dharmasiri, Michelle, Dinsmore, J., Doubal, Fergus N., Hill, A. and Clifton, A. (2021) To support safe provision of mechanical thrombectomy services for patients with acute ischaemic stroke: 2021 consensus guidance from BASP, BSNR, ICSWP, NACCS, and UKNG. Clinical Radiology. (doi:10.1016/j.crad.2021.08.002).

Abstract

Foreword
This document supersedes the existing professional multisociety consensus guidance published in 2015.1 It has been produced in order to respond to the considerable volume of relevant new high-quality trial evidence that has become available since September 2015. It should be emphasised that this document remains applicable to all constituent nations of the UK, and thus, deliberately avoids the use of acronyms or reference to structures that do not pertain to all four nations wherever possible. The guidance was developed (and is now updated) to aid thrombectomy delivery by describing the key requirements for an endovascular stroke therapy service, including the service support requirements and basic performance standards that should be met. Indeed, it substantially influenced the commissioning of thrombectomy by NHS England in 2017.
The standards guidance is intended to support all medical staff and allied health professionals who directly contribute to the delivery of thrombectomy. Both editions of the standards guidance were drawn up through consensus by a working party of appointed representatives from the British Association of Stroke Physicians, the British Society of Neuroradiologists, the Intercollegiate Stroke Working Party, the Neuroanaesthesia and Critical Care Society and the United Kingdom Neurointerventional Group. Drafts were modified in response to review by committees in each society or group. This document draws on publications from other organisations, but is intended to be (whole) UK-focussed, practical, and pathway-orientated. The guidance is a consensus on the minimum service standards required to support a thrombectomy service in terms of specialist staffing/skill mix and the organisation of services. These standards are required in order to minimise the inherent risks related to the mechanical thrombectomy (MT) care pathway and to account for new data from the key trials.
It is recommended that acute stroke thrombectomy should only be undertaken within specialist stroke centres that fulfil agreed standards of care for infrastructure, information technology, imaging equipment, staff, and process. Every centre where such procedures are undertaken has a duty to ensure that safe arrangements are in place. The evidence for thrombectomy efficacy may not be generalisable outside neuroscience/experienced comprehensive stroke centres2 and broad MT implementation without reference to evidence-based professional standards may risk lower individual and population treatment benefit and result in more patient harm.

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