title: Endovascular clot retrieval for acute ischaemic stroke: the Auckland City Hospital experience.
abstract: OBJECTIVE
  In acute ischaemic stroke, endovascular therapy with the Solitaire FR stent retriever has been shown to double recanalisation rates and the numbers of patients who recover to be functionally independent, when compared to standard therapy. We present the Auckland City Hospital experience of clot retrieval.
  
  
  METHODS
  Previously independent ischaemic stroke patients with contraindications to, or no response following, i.v. alteplase, were treated with clot retrieval. All patients had proximal large artery occlusions on CT angiography and many also had CT perfusion scans showing salvageable ischaemic tissue.
  
  
  RESULTS
  Clot retrieval was performed in 33 patients (10 women, mean (SD) age of 54 (17) years) since 2011. Twenty-two (67%) patients were first treated with alteplase. Patients fell into three groups: 17 (52%) had anterior circulation occlusion, similar to those in recent clot retrieval studies; 10 (30%) had posterior circulation occlusion; and six (18%) had 'Rescue' clot retrieval, usually with stroke that followed a procedure. Patients with anterior circulation occlusion had a median time from symptom onset to groin puncture of 225 (range 95-450) minutes, full recanalisation occurred in 76%, and by day 90, all 17 were alive and living at home, with 63% functionally independent (modified Rankin Scale (mRS) 0-2). At day 90, eight of 10 posterior circulation occlusion group patients were alive and living at home, four with a mRS of 0-2. In contrast, four of six 'Rescue' patients had died, and another was functionally dependent with a mRS of 4.
  
  
  CONCLUSIONS
  Endovascular clot retrieval can be safely and effectively performed in a New Zealand setting with similar results to recent trials in anterior circulation occlusion patients. We suggest that District Health Boards develop clot retrieval services as part of regional hyperacute stroke treatment pathways.
authors.affiliation: Department of Neurology, Auckland District Health Board and University of Auckland. a.barber@auckland.ac.nz.
authors.forename: Peter Alan
authors.initials: PA
authors.lastname: Barber
authors.forename: Qiliang
authors.initials: Q
authors.lastname: Liu
authors.forename: Stefan
authors.initials: S
authors.lastname: Brew
authors.forename: Ben
authors.initials: B
authors.lastname: McGuinness
authors.forename: Ayton
authors.initials: A
authors.lastname: Hope
authors.forename: Maurice
authors.initials: M
authors.lastname: Moriarty
authors.forename: Doug
authors.initials: D
authors.lastname: Campbell
authors.forename: Dominic
authors.initials: D
authors.lastname: Tse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007362:Intensive Care Units; D020767:Intracranial Thrombosis / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D015607:Stents; D020521:Stroke / Q000209:etiology* / Q000628:therapy; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator