In this section : Referral
: Stroke and TIA
Styroke Thrombectomy Pathway
Management of Hypertension in Acute Stroke
Stroke Care
Stroke – Post Thrombolysis
Stroke Thrombolysis
Styroke Thrombectomy Pathway
Last updated 21st January 2025
Thrombectomy Operating Times
- The Thrombectomy Pathway will operate Monday to Friday within core hours when senior clinical decision makers are present in DGRI.
- DGRI – All referrals must be discussed with the senior stroke team – Amy Conley / Ritesh Malik
- QUEH Referrals – Earliest referral call to QEUH 09:00. Latest transfer to QEUH will be 12.45.
Note – Thrombectomy should not prevent the initiation of thrombolysis when indicated
Thrombectomy Referral Criteria
- For anterior circulation stroke, if ALL of the following criteria are answered YES then patient meets referral criteria for thrombectomy:
- Aged ≥18
- Pre morbid MRS 0-2
- NIHSS >5 or NIHSS <5 with disabling symptoms e.g. aphasia
- Large vessel occlusion: ICA/M1/M2 or Proximal A1
- Presentation within 24 hours of symptoms or last well seen
- Fit for transfer to hub
- No Haemorrhage or relevant non-stroke pathology on CT brain
- ASPECTS score on CT Head scan >5
- CTP (beyond 6hrs or unknown onset) – core volume <70ml
- No severe cardiorespiratory issues which could prevent general anaesthesia
- For posterior circulation stroke, if ALL of the following criteria are answered YES then patient meets referral criteria for thrombectomy:
- Aged ≥18
- Pre-morbid MRS 0-2
- Presentation within 24 hours of symptoms or last well seen
- Fit for transfer to hub
- Large vessel occlusion – basilar or dominant vertebral artery
- No severe cardiorespiratory issues which could prevent general anaesthesia
- Based on CT head and CTA within 6 to 12 hours of symptom onset/last seen well, the decision to proceed with Thrombectomy is on an individual basis following discussion with the stroke consultant at the Hub/QEUH.
- Any other suitable patients for thrombectomy outwith above criteria – senior referring clinician to discuss with QEUH strok consultant.
How to Make the Referral
- Referral to the hub should be made by the responsible consultant on call for the spoke unit.
- Referral to be made to the QEUH Stroke Consultant on call – Contact via QEUH Switchboard on call telephone number 0141 201 1000.
Arranging Transfer to the Hub
- Advise call handler that it is a thrombectomy transfer – this will require a red response.
- Once a patient has been accepted for referral to the hub, the spoke unit should inform the patients and their family that they are being transferred to QEUH for consideration for thrombectomy.
Links
Content by Amy Conley, Ritesh Malik and Aaron Jardine