Below we present a description of 12 potential options for delivering thrombectomy with an explanatory footnotes (where required). Please score each of the 12 options using a 7-point Likert scale: |
1. Any local provider “ad hoc”a |
2. Any local provider delivers IAT on a formal rotab |
3. Transfer to nearest primary coronary percutaneous intervention unit and cardiology managec |
4. Transfer to nearest primary coronary percutaneous intervention unit and shared care with stroke physiciansd |
5. Ambulance bypass for all acute stroke patients of known time onset to comprehensive stroke unit where advanced imaging and “expert intra-arterial thrombectomy [IAT]” are available 24/7e |
6. Local CT and transfer all patients with NIHSS ≥10 to the nearest neuroscience centre for interventional neuroradiologist delivered “expert thrombectomy”f |
7. Local CT/CTA then transfer all large artery occlusive stroke patients to nearest neuroscience centre for interventional neuroradiologist delivered “expert thrombectomy”g |
8. Local advanced imaging then selective transfer to nearest neuroscience centre for “expert thrombectomy”h |
9. Local CT/CTA then transfer large artery occlusive stroke patients to nearest neuroscience centre for advanced imaging and “expert thrombectomy” |
10. Advanced imaging performed locally but interpreted centrally by Neuroradiology then selective transfer to nearest neuroscience centre for “expert thrombectomy” |
11. Selective transfer to nearest on call neuroscience centre for “expert thrombectomy”i |
12. Interventional neuroradiologist and necessary support team on standby in Neuroscience centre – they transfer to patient’s hospital to deliver expert intra-arterial thrombectomy when large arterial occlusion stroke is confirmedj |