The Evolution of Mechanical Thrombectomy for Acute Ischaemic Stroke: A Decade In Dublin

Abstract Background The advent of mechanical thrombectomy (MT) has entirely transformed hyperacute care for patients with stroke. We studied changing trends in MT provision over a decade, spanning participation in pivotal randomised controlled trials, evolving neuro-interventional techniques, a global pandemic and expanding treatment indications in a comprehensive stroke centre in Dublin. Methods Consecutive patients treated with MT were prospectively recorded between January 2012 and December 2022. We compared baseline clinical and imaging data, treatment times and procedural and clinical outcomes both on an annual basis and across the totality of the epoch. Results 2211 MT patients were recorded. Total annual numbers were: 36 (2012), 53 (2013), 46 (2014), 122 (2015), 172 (2016), 248 (2017), 262 (2018), 306 (2019), 301 (2020), 326 (2021) and 338 (2022). Between 2012 and 2022 patients treated with MT became older (mean age: 65.6yrs (SD:13.8) vs 70.0yrs (SD: 14.6); p=0.017), had greater infarct volumes (median baseline ASPECTS: 10 (IQR:9-10) vs 9(IQR:8-10): p=0.045) and were treated faster (median door-to-recanalisation: 70mins vs 39 mins; p0.0001). Patients were less likely to have witnessed stroke onset (100% vs 54%; p0.0001), receive IV tPA (72% vs 38%; p0.0001) or have thrombus located in the intracranial ICA or M1-MCA (95% vs 65%: P0.0001). No significant variations in pre-stroke mRS, baseline NIHSS, onset-to-recanalisation times, rates of successful recanalisation (86% vs 91%: p0.29) or 90-day mRS (0-2: 44% vs 50%; p0.68) were observed. Conclusion As our service has evolved, patients presenting for MT have become more complex, are treated faster and continue to achieve excellent clinical and radiological outcomes.