A retrospective audit of out-of-hours mechanical thrombectomy of anterior circulation large vessel occlusion in a UK tertiary centre

Mechanical thrombectomy (MT) is indicated for patients with acute ischemic stroke resulting from large vessel occlusion (LVO). At Hull Royal Infirmary (HRI), the MT service is available from 08:00 h to 16:00 h, Monday to Friday. Consequently, many patients who present outside of those times are denied a chance of having this treatment. The objective of this audit was to detect the percentage of patients who had presented out of hours and managed to have MT and to identify why the remaining proportion of patients did not receive this treatment. A total of 35 patients with anterior circulation LVO who presented out of hours and on weekends were included in this audit. Of these, only six patients (17%) received MT. Selection of those patients was favoured by their early-morning presentation shortly before the opening of the MT service at 08:00 h. Thus, a substantial number of patients presenting with LVO out of hours were not considered for MT. This could be attributed to inadequate communication between staff. Initiation of an in-hospital protocol could facilitate communication between stroke physicians and neuroradiologists and provide a pathway for consideration of such patients for late-window MT.