Development of a new regional unit for mechanical thombectomy and malignant middle cerebral artery infarction in Wessex

Marigold, R, Weir, N., Crawford, P., Evans, S., Battersby Wood, E., Siddegowda, S., Lovett, J., Colchester, N, Morris, R and Slaght, S (2018) Development of a new regional unit for mechanical thombectomy and malignant middle cerebral artery infarction in Wessex. International Journal of Stroke, 14 (4S), 35. (doi:10.1177/1747493019882907).

Abstract

Introduction: Mechanical thrombectomy (MT) in Wessex is increasing as an acute stroke intervention. So far in 2019, there have been 51 referrals and 22 procedures performed. A new 3 bedded hyperacute bay has been created to facilitate regional transfers with a view to optimising neurological outcomes.

Method: In our hospital, MT is performed by 4 interventional neuroradiologists using a "drip and ship"(thrombolysis then thrombectomy) model supporting a population of 2.8 million and 8 district general hospitals. The current service operates weekdays, 08:30-17:00. Early recognition of the need to create a defined hyperacute area to receive, treat and monitor MT patients was identified and a
business case and estate renovation plan implemented.

Results: The new unit opened at the end of May 2019 and is supported by 5 stroke physicians, 1 stroke neurologist and 4 neurologists. Initial models suggest that between 300–500 patients per year in Wessex may benefit from MT if 10% of the ischaemic stroke population are treated. The beds are specialist commissioned and subsequently ringfenced for patients requiring transfer for thrombectomy
or hemicraniectomy.

Conclusion: This innovative facility enables thrombectomy and stroke hemicraniectomy care to be consolidated and expertise developed in a defined hyperacute area. Training programmes including stroke simulation are planned to upskill team members. Future challenges include the development of
perfusion scanning to expand time windows for intervention, increasing interventional radiology support to increase out of hours provision, and enabling the pathway across the region.

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