Indication for Neurointervention Of the 852 total NI procedures performed by the unit for this year, 489 were treatment procedures. Figure 5 shows the breakdown of indication for these treatment procedures with 40.5% of these required for the treatment of vasospasm. Notes: • Numbers for emergency and elective neurointerventional cases have been included, and • “Other” indication category includes stenosis, tumour and Middle Meningeal Artery (MMA) embolisation.
Emergency Stroke Cases
Treatment procedures
ECR pathway activation
Acute ischaemic stroke is usually caused by arterial thrombosis or embolus. Endovascular clot retrieval (ECR) aims to remove obstructing blood clots in ischaemic stroke patients who have large vessel occlusions (LVOs); thereby restoring blood flow to the brain and minimising brain tissue damage. Patients suspected of LVOs require rapid assessment, early intervention, and specialised post procedural care. For ECR to be clinically effective, it needs to be performed as soon as possible and to a high standard of procedural excellence. Without this, clinical trials have proven the procedure to be futile. Any patient who presents or is referred to RNSH with an LVO will activate the acute stroke and/or ECR pathway. This includes patients who underwent ECR; had LVOs and underwent DSA (without ECR) or who were transferred for ECR consideration and underwent conservative management. The acute stroke pathway is activated when patients are identified to have acute stroke symptoms. The pathway initiates a rapid neurological assessment by the specialised stroke team, with rapid access neuroimaging needed to make a diagnosis and identify treatment options. The ECR pathway can be activated for select patients with confirmed LVOs, bypassing resuscitation and/or medical imaging, to allow the patient to be transferred directly to the angiography table to minimise treatment delays. In 2021, 138 procedures activated the ECR pathway, representing 16.2% of all INR procedures. This includes procedures performed on confirmed LVO patients, including ECR, IA tPA, and DSA only (due to distal clot migration or inability to access occlusion site). Of the 138 pathway activations, 111 (80.4%) were for treatment and 27 (19.6%) were DSA only.
Figure 5: Indication for neurointervention
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Neurointervention Unit Annual Report 2021
Neurointervention Unit Annual Report 2021
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