A Three-year Comprehensive Stroke Centre Development Journey: Improving Door-to-Groin Puncture Time and Patient Outcomes for Mechanical Thrombectomy in Nottingham University Hospitals in the United Kingdom

¹Joshua Wong,¹Ashit Kumar Shetty, ¹Ashit Kumar Shetty

¹Nottingham University Hospitals NHS Trust

Introduction:

In patients with strokes caused by large vessel occlusions (LVO), delays in door-to-groin puncture time (DGPT) are associated with worse clinical outcomes. Nottingham University Hospitals (NUH) provides the East Midlands’ Mechanical Thrombectomy (MT) service in the United Kingdom. We present results from a series of changes leading to the development of the NUH Comprehensive Stroke Centre with a view to show improvement in DGPT and patient outcomes.

Material(s) and Method(s):

242 patients admitted from eight hospitals across the Trust’s referral network underwent Mechanical Thrombectomy (MT) between January 2019 and January 2022. The development of the NUH Comprehensive Stroke Centre included a relocation of the stroke services from Nottingham City Hospital to Queens’ Medical Centre (QMC), a major trauma centre where interventional services including MT and neurosurgery are based, as well as the integration of stroke assessment within the QMC Emergency Department pathways.

Result(s):

Comparing the outcomes before (n=131) and after (n=111) our interventions in patients with a mean age of 69.9 and 70.2 years respectively demonstrated a reduction in DGPT time from 5.6 to 3.4 hours, improvement in the average modified Rankin Score on discharge from 3.71 to 3.67 and NIHSS improvement at 24 hours post-MT from 8.43 to 8.46.

Conclusion(s):

Our interventions led to a reduction in DGPT time and better functional outcomes. A comparable NIHSS improvement may be due to an increase in the proportion of patients eligible for MT (e.g. change in the selection criteria to beyond 6 hours after symptom onset). Further studies are required to establish the effects of our interventions in the long term.