North Bristol Trust: Thrombectomy Referral Criteria – External Hospitals
Thrombectomy service for patients from the Severn region, England operate 24:7.
Referrals will be received from all other hospitals 8am to 5pm.
Patients referred must be able to arrive at Southmead by 6pm.
Referrals should be made via Homepage (referapatient.org) to North Bristol Trust in the first instance
(Search ‘Mechanical Thrombectomy’ and ‘Southmead Hospital’)
If no response is received in 10 minutes, please phone the thrombectomy phone directly
07784 359723
In case of difficulties, alternative contacts are stroke registrar bleep 1490, or ANPs 0117 9549092.
Before referral, the following should have been carried out:
- Upload of all new brain imaging to cloud portal (Biotronics 3Dnet).
- Input all referral information via: Homepage (referapatient.org)
- Where intravenous thrombolysis is indicated this should not be delayed.
Referrals should fulfil all of the following criteria:
Clinical
- NIHSS >= 6 or disabling/fluctuating deficit
- Independent before the index stroke (modified Rankin Scale 0-2).
- Fit for emergency transfer. If concerns exist regarding patients being safe for inter-hospital transfer seek advice from local anaesthetic / critical care team
- Sufficiently well to benefit from treatment. This includes co-morbidities and frailty; while age influences fitness for treatment age does not by itself limit capacity to benefit.
Radiological
- All patients should undergo a NCCT and CTA with coverage from aortic arch to the vertex*
- This should be uploaded to Biotronics 3DNet routinely,
- This should have a local diagnosis of an LVO (carotid-T, M1, proximal M2 or tandem occlusions) via a consultant radiologist or automated post processing tool such as Rapid or Brainomix.
*Multi or dual phase CT angiography is preferred.
- For patients arriving at Southmead within 6 hours:
- NCCT and CT angiography is required.
- For patients arriving at Southmead within 12 hours:
- NCCT and CT angiography is required.
- Minimal early ischaemic change required (defined as NCCT ASPECTS >= 5 if perfusion imaging is not available locally).
- Additional CT perfusion with automated post processing is preferable.
- For patients arriving at Southmead between 12 and 24 hours:
- NCCT, CT angiography and CT perfusion is required.
NOTE: If a patient does not fulfil the above criteria but it is felt that they would benefit from treatment, for example young patient with large ischaemic core, basilar occlusion, referrals will still be considered
Please ensure a ReSPECT form has been completed prior to transfer