1Joshua Wong,1Ashit Kumar Shetty, 1Ashit Kumar Shetty
1Nottingham University Hospitals NHS Trust
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.
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.
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.