Neurocritical Care Support of Endovascular Mechanical Thrombectomy

Abstract

Background Acute ischemic stroke (AIS) is a leading cause of morbidity and mortality, where timely intervention with mechanical thrombectomy (MT) is crucial for restoring cerebral blood flow and improving patient outcomes. This study evaluates the impact of a dedicated Neurocritical Care Rapid Response Team (NCC-RRT) on MT workflow efficiency and patient outcomes. Methods We conducted a prospective analysis of AIS patients undergoing MT at a Comprehensive Stroke Center between January 2021 and December 2023. The study compared two periods: Era 1 (pre-NCC-RRT, January-October 2021) and Era 2 (post-NCC-RRT, December 2021-December 2023). The NCC-RRT was responsible for the expedited transfer, airway management, procedural analgosedation, and hemodynamic support. Key metrics, including door-to-groin-puncture (DTGP) and door-to-recanalization (DTR) times, were analyzed. Results A total of 395 patients were included in the study. The implementation of the NCC-RRT significantly reduced DTGP and DTR times, particularly in patients receiving general anesthesia (GA). The NCC-RRT was associated with a 14.3% reduction in groin-puncture-to-recanalization time and a 26.6% increase in GA utilization. Additionally, significant time reductions were observed in both direct ED presentations and transferred patients. Conclusions The introduction of a dedicated NCC-RRT led to substantial improvements in MT process efficiency, highlighting the critical role of neurocritical care in optimizing stroke treatment and enhancing patient outcomes. This model offers an effective alternative for centers where dedicated neuroanesthesia teams are unavailable.