Characteristics of intra-arterial thrombectomy service provision in England.

Abstract

Introduction: Intra-arterial thrombectomy (IAT) is an effective treatment for large artery occlusive stroke. However, there is a pressing need for data on the (cost-) effectiveness of different models of IAT service provision. To inform a model to estimate the impact of different service configurations for delivery of IAT, we determined current characteristics of interventional neuroradiology services in England. Method: A survey instrument was emailed to all 24 IAT services in England to request data on provision of IAT, patient selection criteria, diagnostic imaging resources required and opinions on future IAT service provision. Results: 18 centres provided responses to the survey (75% response) with a median of 3 (IQR = 1) interventional neuroradiologists (INRs). 10 (56%) centres had formal IAT protocols and 6 protocols for inter-hospital transfers. 1 centre claimed it had 24/7 IAT provision. A majority (n = 16; 89%) required only computed tomography (CT) or CT angiography (CTA) but most required expert radiology review of CTA. There was variable use of different imaging scoring systems, including variation across centres in terms of factors influencing patient selection for IAT (e.g. NIHSS). There was minor variation between units in terms of anaesthesia technique, undertaking/approach used in IAT when complete carotid occlusion was present. Most centres (n = 16, 89%) did not administer heparin or anti-platelets during IAT. Model preferences for future IAT provision were delivery by INRs in a network where necessary, drip and ship inter-hospital transfers, and anaesthetic support via crash type systems. Discussion: There is incomplete consensus on the organisation of future service provision for IAT in England.