Camelia Ionela Ralea Masdrag
Introduction Mechanical thrombectomy (MT) has become the gold standard treatment for acute ischemic strokes (AIS) due to large vessel occlusion. MT is almost entirely delivered by established teams in large interventional neuroradiology centers. Access to such centers often induces a delay in time from symptoms to reperfusion, especially when AIS patients arrive initially in primary care centers. Aim: To assess the feasibility of installing MT in a regional center and to assess the performance of the procedure during the first year of realization. Methods: Data from the prospectively maintained database of patients undergoing MT for AIS at the A.Paré Hospital (Mons, Belgium) between 11.06.2017 and 11.06.2018 were reviewed. Demographic, procedural, and outcome variables were collected. Results: Availability of MT was organized in two phases: firstly during office hours and secondarily 24/7. Emergency care pathway reorganization and availability of on-call staff were the most challenging steps of MT installation. During the first 12 months of availability in our center, MT was performed in 23 cases. Five patients were transferred specifically for MT to our center from another stroke center. Average door to groin was 96 +/- 46 min. Average groin to reperfusion was 43 +/- 22 minutes. Efficient reperfusion (TICI score ≥ 2b-3) was achieved in 90.9% (20/22 cases, no thrombus identified in one patient). Conclusions: Initiating MT for acute stroke reperfusion in a regional center is challenging but possible. Well organized small teams can achieve recommended door to groin times and high reperfusion rates even within the first year of their practice.
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