Delivering thrombectomy for acute stroke using cardiology services

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h3969 (Published 27 July 2015) Cite this as: BMJ 2015;351:h3969
  1. Andrew Apps, cardiology registrar1,
  2. Soroosh Firoozan, cardiology consultant1,
  3. Tito Kabir, cardiology consultant2
  1. 1Department of Cardiology, High Wycombe Hospital, Bucks, HP11 2TT, UK
  2. 2Harefield Hospital, Middlesex, UK
  1. Correspondence to: A Apps drandyapps{at}gmail.com

Why should the location of an acutely occluded artery affect who gets treated?

Evidence is mounting for the supplementary benefit over thrombolysis of endovascular therapy in selected patients with acute stroke. Mechanical percutaneous removal of intracerebral clot using an aspiration catheter ensures that the artery is recanalised. Like thrombolysis, the benefits are greater with early treatment, and we need to think about how to achieve this. Evidence on the benefits of rapid primary percutaneous coronary intervention in patients presenting with ST segment elevation myocardial infarction (STEMI) led to a network being set up in the United Kingdom to provide 24 hour care.1 Teams staffing these networks, skilled in opening arteries quickly, could also provide endovascular therapy to selected patients with acute stroke.

Optimal treatment

Patients with acute stroke should have thrombolysis within 4.5 hours of the onset of symptoms, after bleeding has been excluded.2 The most recent meta-analysis comparing thrombolysis with conservative management3 found that, if administered within three hours, the number needed to treat (NNT) to achieve one further independent patient (modified Rankin score of 0-2) is 11.3 Delay diminishes benefit; if thrombolysis is given …

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