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Endovascular clot retrieval for acute stroke in outer metropolitan sydney

Objectives Endovascular clot retrieval (ECR) is now the standard of care for selected patients with acute stroke,1 however there are few centres where it is performed. Nepean Hospital is a tertiary hospital located over 50 km from the major ECR centres in Sydney. We aimed to review the feasibility, process, and outcomes for ECR referrals from our facility. Methods Case series of patients referred for ECR between 1 February 2016 and 1 February 2017. Results Data was available for 10 patients, of whom eight patients (80%) underwent ECR following transfer. The mean patient age was 64.5 years (range 42–78) and mean baseline NIH stroke scale (NIHSS) was 11.8 (range 0–20). Six patients (60%) received intravenous alteplase (tPA) prior to transfer with a median onset-to-needle time of 187 min (IQR 123–223). IV tPA was contraindicated in the other four patients. The median time from neuroimaging to transfer acceptance was 70 min (IQR 50–95), with a further wait of 50 min (IQR 29–62) for ambulance transport to depart. The median road transport time was 59 min (IQR 55–60). Median onset-to-groin puncture time was 334 min (IQR 299–337). Successful reperfusion (mTICI 2B/3) was achieved in all patients who underwent ECR. Overall, 5/8 patients (62.5%) who underwent ECR achieved an excellent outcome (modified Rankin Scale 0–1). No patient developed anaphylaxis or acute kidney injury. Two patients died, both of whom were referred outside of the current guidelines. Conclusions ECR in patients from outer metropolitan Sydney is feasible and achieves good outcomes when guideline-based selection criteria are used, despite geographical barriers and the lack of a state-wide service in NSW. Potential areas of improvement include streamlining the referral and transfer process.