Real-world effects of late window neurothrombectomy: Procedure rates increase without night-time bias

Michelle Marie Williams, Thabele Leslie-Mazwi, Joshua A. Hirsch, Carol Kittel, Alejandro Spiotta, Reade De Leacy, J. Mocco, Felipe Albuquerque, Andrew Ducruet, Nitin Goyal, Adam S. Arthur, Peter Kan, Maxim Mokin, Travis M. Dumont, Alan Reeves, Stacey Q. Wolfe, Kyle Fargen

Research output: Contribution to journalArticle

Abstract

Introduction: With the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures. Methods: Neurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24-hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017. Results: Data were collected from a total of 300 days of call. A total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24-hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87% of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37% between the hours of 16:00 and 20:00. Conclusions: MT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. Compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams.

Original languageEnglish (US)
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - Jan 1 2019

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Thrombectomy
Referral and Consultation
Stroke
Prospective Studies
Physicians

Keywords

  • Angiography
  • Intervention
  • Stroke
  • Thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Williams, M. M., Leslie-Mazwi, T., Hirsch, J. A., Kittel, C., Spiotta, A., De Leacy, R., ... Fargen, K. (Accepted/In press). Real-world effects of late window neurothrombectomy: Procedure rates increase without night-time bias. Journal of neurointerventional surgery. https://doi.org/10.1136/neurintsurg-2019-015223

Real-world effects of late window neurothrombectomy : Procedure rates increase without night-time bias. / Williams, Michelle Marie; Leslie-Mazwi, Thabele; Hirsch, Joshua A.; Kittel, Carol; Spiotta, Alejandro; De Leacy, Reade; Mocco, J.; Albuquerque, Felipe; Ducruet, Andrew; Goyal, Nitin; Arthur, Adam S.; Kan, Peter; Mokin, Maxim; Dumont, Travis M.; Reeves, Alan; Wolfe, Stacey Q.; Fargen, Kyle.

In: Journal of neurointerventional surgery, 01.01.2019.

Research output: Contribution to journalArticle

Williams, MM, Leslie-Mazwi, T, Hirsch, JA, Kittel, C, Spiotta, A, De Leacy, R, Mocco, J, Albuquerque, F, Ducruet, A, Goyal, N, Arthur, AS, Kan, P, Mokin, M, Dumont, TM, Reeves, A, Wolfe, SQ & Fargen, K 2019, 'Real-world effects of late window neurothrombectomy: Procedure rates increase without night-time bias', Journal of neurointerventional surgery. https://doi.org/10.1136/neurintsurg-2019-015223
Williams, Michelle Marie ; Leslie-Mazwi, Thabele ; Hirsch, Joshua A. ; Kittel, Carol ; Spiotta, Alejandro ; De Leacy, Reade ; Mocco, J. ; Albuquerque, Felipe ; Ducruet, Andrew ; Goyal, Nitin ; Arthur, Adam S. ; Kan, Peter ; Mokin, Maxim ; Dumont, Travis M. ; Reeves, Alan ; Wolfe, Stacey Q. ; Fargen, Kyle. / Real-world effects of late window neurothrombectomy : Procedure rates increase without night-time bias. In: Journal of neurointerventional surgery. 2019.
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abstract = "Introduction: With the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures. Methods: Neurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24-hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017. Results: Data were collected from a total of 300 days of call. A total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24-hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87{\%} of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37{\%} between the hours of 16:00 and 20:00. Conclusions: MT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. Compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams.",
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author = "Williams, {Michelle Marie} and Thabele Leslie-Mazwi and Hirsch, {Joshua A.} and Carol Kittel and Alejandro Spiotta and {De Leacy}, Reade and J. Mocco and Felipe Albuquerque and Andrew Ducruet and Nitin Goyal and Arthur, {Adam S.} and Peter Kan and Maxim Mokin and Dumont, {Travis M.} and Alan Reeves and Wolfe, {Stacey Q.} and Kyle Fargen",
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T1 - Real-world effects of late window neurothrombectomy

T2 - Procedure rates increase without night-time bias

AU - Williams, Michelle Marie

AU - Leslie-Mazwi, Thabele

AU - Hirsch, Joshua A.

AU - Kittel, Carol

AU - Spiotta, Alejandro

AU - De Leacy, Reade

AU - Mocco, J.

AU - Albuquerque, Felipe

AU - Ducruet, Andrew

AU - Goyal, Nitin

AU - Arthur, Adam S.

AU - Kan, Peter

AU - Mokin, Maxim

AU - Dumont, Travis M.

AU - Reeves, Alan

AU - Wolfe, Stacey Q.

AU - Fargen, Kyle

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: With the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures. Methods: Neurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24-hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017. Results: Data were collected from a total of 300 days of call. A total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24-hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87% of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37% between the hours of 16:00 and 20:00. Conclusions: MT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. Compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams.

AB - Introduction: With the expansion of the interventional time window for stroke from emergent large vessel occlusion (ELVO), the rate of mechanical thrombectomy (MT) is expected to rise, potentially causing higher burnout rates and requiring hospitals to develop strategies for adequate coverage of these procedures. Methods: Neurointerventional physicians at 10 participating stroke centers prospectively recorded time requirements for all MT consultations over 30 consecutive 24-hour call periods, including both false positive consultations and MT procedures, during mid to late 2018. Consult start time, procedure start and end time, and data regarding commute to the hospital and delay in scheduled procedures were collected and compared with those from an identical prospective study performed in 2017. Results: Data were collected from a total of 300 days of call. A total of 166 procedures were performed (mean 0.55 per day), an increase from 0.32 per day in 2017. Overall mean MT direct time burden during each 24-hour call was 124 min (compared with 85 min in 2017). The percentage of consultations for thrombectomy varied based on time of day, with 87% of consults between the hours of midnight and 04:00 proceeding to thrombectomy compared with 37% between the hours of 16:00 and 20:00. Conclusions: MT procedural volumes have increased from one every 5 days in 2016 to one every 2 days in 2018. The highest percentage of consults leading to thrombectomy occur in the early morning hours after midnight. Compared with similar data from 2016 and 2017, call demands continue to escalate, representing a significant demand on neurointerventional teams.

KW - Angiography

KW - Intervention

KW - Stroke

KW - Thrombectomy

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DO - 10.1136/neurintsurg-2019-015223

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JO - Journal of NeuroInterventional Surgery

JF - Journal of NeuroInterventional Surgery

SN - 1759-8478

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