Air retrieval for clot retrieval; time metrics and outcomes of rural stroke patients air-transported for mechanical thrombectomy at a state stroke unit

Dr Andrew Hooper1, Dr Matthew Crockett2, Dr Nihar Jha2, Dr McAuliffe William2, Dr A Chiu2, Dr T Phillips2, Dr T Singh2

1RFDS Western Operations, Jandakot, Australia, 2Neurological Intervention and Imaging Service of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Australia

Since 2015, several landmark studies (1-4) have provided conclusive evidence to support the utilization of mechanical thrombectomy (MT) as the first line treatment of emergent large vessel occlusion (LVO) anterior circulation stroke, with data indicating a number needed to treat of just 2.6 in order to reduce patient disability (5). Whilst early trials demonstrated the efficacy of MT from 6-12 hours from symptom onset, more recent studies have extended this timeframe up to 24 hours in selected patients (6,7) further increasing the proportion of LVO stroke patients eligible for MT.

Providing 24/7 access to MT services to the largest proportion of the population as possible has thus become a priority and has required significant reconfiguration of systems and resources. Centralisation of MT services to high volume centres results in improved patient outcomes and fewer complications (8,9), however providing MT services to remote or rural regions with small, dispersed populations  presents a particular challenge. Sustaining a viable local MT centre in such regions is not feasible and therefore patients suffering an LVO stroke require rapid medical transfer to the closest MT centre, most commonly in the nearest metropolitan region. Given the potentially large distances involved and the time sensitive nature of the condition, such transfers often necessitate aeromedical retrieval; however there is a paucity of data on the logistics, time-metrics and outcomes of patients transported by air for MT.

The aim of this paper is to present time-metric and outcome data on LVO stroke patients who have undergone MT following aeromedical retrieval from the vast rural catchment of our state mechanical thrombectomy unit.


Biography:

Dr Andy Hooper is the Head of Medical Services at RFDS Western Operations.  He has a passion for providing the highest standard of healthcare to patients in remote and regional Australia

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