Intra-Arterial Thrombolysis/ Mechanical Thrombectomy (IAT/MT) Procedures

Intra-arterial thrombolysis/ mechanical thrombectomy (IAT/MT) procedures

Potential patient for IAT/MT identified Fit for GA/ thrombectomy Previously independent NIHSS>=10 or basilar artery thrombus No bleed or sub acute infarct on CT head CTA shows large vessel occlusion (ICA/M1/M2/ VA/BA/ PCA)

 Inform IAT/MT consultant on call via switch (Prof Roffe/ Dr. Natarajan/ Dr Sanyal)  Inform interventional neuroradiologist (Dr Nayak via switch)

If decision made to proceed to IAT: TIME IS BRAIN 2000 brain cells die per minute of untreated ischaemia!

1. Intravenous thrombolysis  A&E doctor to start IV lysis immediately unless contraindicated or already running, give 80% of calculated dose keep 20% for potential IA use.

2. Get the team  Keep next of kin on site for consent /queries or establish contact route

 Stroke physician (or radiologist/ A&E doctor of stroke physician not on site) to get an anaesthetist (bleep 829 available 24/07) STAT to book case as an emergency (E1) and to arrange for an ODA to attend. Make sure you have details of patient at hand.

 If possible, a member from the stroke team should go down to the main theatres and book the case as an emergency (this is ideal but not mandatory).

 Radiologist to get radiographer and scrub nurse for the procedure. Set up operating trolley and equipment immediately.

 For patients transferred from other hospital inform anaesthetist (bleep 829) as soon as call taken so that they can prepare.

3. Prepare the patient (A&E staff/ stroke team/ neuro-interventionalist)  Discuss procedure  Complete consent form  Complete theatre checklist (inside the consent form)  Put patient into a theatre gown  Offer bottle or catheterize  Put in IA line (in A&E or theatre)  Transfer to neuro-interventnional theatre . 4. Prepare for intervention (downloadable from www.thrombolysis.info) Start the intra-arterial intervention log (use paper form or Theatre team to move patient onto the intervention table Theatre team to cover patient with sterile sheets Anaesthetist and ODA to commence local/ general anaesthesia Neuroradiologist or scrub nurse to clean/ disinfect groin.

5. During / after the intervention Complete intra-arterial intervention log (paper form, or Excel data entry file) Remove catheter/ intra-arterial line Liaise with ASU to ensure a bed is available Get a bed tracked to the intervention suite to transfer patient to ASU Patients who were ventilated before the procedure may need ITU/MIU.