Background/Aims
Endovascular clot retrieval is an effective hyperacute interventional treatment for stroke with large vessel occlusion. Endovascular clot retrieval is time critical, each 1-minute delay results in the loss of 1.9 million neurons due to ischaemia. Efficient workflow and timely patient transfer to hospitals capable of performing the procedure is required. This workflow has not been investigated in the Murrumbidgee Local Health District.
Methods
An observational, retrospective, cohort study examined referrals from Wagga Wagga Base Hospital to Canberra Hospital for endovascular clot retrieval opinion between January 2020 and December 2023. Descriptive analysis and linear regression compared time metrics for transferred patients.
Results
A total of 52 participants were recruited. Participant mean age was 70.5 years (SD 12), 34 (65.4%) were male. Median time from stroke onset to groin puncture was 465 minutes (IQR, 385-676). Majority of time (37.41%) was spent from transfer acceptance to transport arrival. Secondly, 33.60% of time was spent pre-hospital from stroke onset to triage at Wagga Wagga Base Hospital. Thrombolysis did not delay arrival at the Canberra Hospital. Patients referred with no intention for endovascular clot retrieval were transferred at a much slower speed.
Conclusion
Several time delays were identified across the process of accessing clot retrieval services. Optimisation of systems involved in the urgent transport of regional patients for endovascular clot retrieval is needed to minimise delays and achieve best outcomes. Review of alternative neurointerventional delivery care models in regional areas is needed for possible uptake to improve timely access to endovascular clot retrieval services.