Executive Summary
2021 Highlights
The biggest highlight for the NI Unit in 2021 was the exciting announcement of funding for the construction of two theatres, and the installation of one biplane angiogram machine in the RNSH operating theatres, with the first stage expected to be completed in August 2022. On top of this, RNSH purchased a Rampart radiation protection system, a conformable radiation protection shield that removes the need for the operator and scrub teams to wear heavy lead radiation garments. The system was trialed in 2021 and will be a welcome addition when installed in 2022. Throughout 2021, the NI Unit worked closely with the Emergency, Medical Imaging, Anaesthetic and Recovery, Neurosurgery, Neurology and Executive departments to expand the Endovascular Clot Retrieval (ECR) service at RNSH. The ECR service hours were extended to 10pm, 7 days a week in 2021, with 86% of ECR pathway activations being treated at RNSH. The team continues to work collaboratively with all these units to reach the goal of extending to a 24/7 ECR service in 2022. Due to the COVID-19 pandemic and resultant operating list cancellations, bed blocks and staff furloughs, the NI Unit’s activity slightly decreased by 1.3% compared to 2020, however this still represents an overall increase of 40.6% since 2017. Combined, digital subtraction angiography (DSA) and emergency neurointerventions were the majority (75.6%) of procedures performed during 2021, with acute stroke treatment representing 12.8%, and non-neuro and elective NI procedures contributing to 11.6% of the activity. During 2021, the NI Unit started recruitment on two Royal North Shore investigator-driven studies. This included a trial on the use of pharmacogenomics selection in neurointervention and also a collaboration with the Neurology Department on the MOSS study – Medium Vessel Occlusion Study, using intra-arterial tenecteplase (TNK). In the same year, the unit also
completed recruitment for a major international study DIRECT SAFE – optimising the treatment of large vessel stroke. This landmark study was published in the medical journal - The Lancet . As a unit, we continued to build on our strong research collaboration, with involvement in the Monitoring Of Stroke Endovascular Services (MOSES) – a neuroimaging repository for acute stroke, and appointed our first Neurointerventional Research Associate. We also contributed to the major international observational study on COVID-19, stroke and subarachnoid haemorrhage with Boston and Emory Universities. The unit has published 7 research articles last year and continue to collaborate with both local and international researchers. Future opportunities to strengthen the service include, identifying beds for neurovascular and acute stroke patients, maximising available theatre time, transitioning to 24/7 ECR service and developing the potential to treat a wider indication for ECR. The unit looks forward to showcasing the first stage of the new neurointerventional suite later this year and is committed to continuing to provide high quality service across the community.
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Neurointervention Unit Annual Report 2021
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