Thrombectomy

Mechanical Thrombectomy EVT is a rapid-access clinical decision support tool covering the complete large vessel occlusion (LVO) management pathway from team activation through to post-EVT care. Built by a Neurology and Stroke Fellow and referenced to HERMES 2016, DAWN 2018, DEFUSE-3, ANGEL-ASPECT, SELECT-2, EXTEND-IA TNK, NICE 2024, and RCP 2023.

Default to EVT — prove ineligibility, not eligibility. Every 15 minutes of delay = ~4% reduction in good outcome.

8-STEP EVT PATHWAY:

Step 1 — LVO Activation and Immediate Checklist
- Simultaneous team activation — stroke consultant, neuroradiology, INR team
- Parallel patient assessment checklist
- LVO clinical indicators

Step 2 — RACE and LAMS Score Calculators
- Interactive RACE calculator — threshold 5+, LVO likely
- Interactive LAMS calculator — threshold 4+, direct to TCC
- Transport decision — TCC vs HASU, drip-and-ship

Step 3 — CT Trifecta and ASPECTS Calculator
- NCCT + CTA + CTP protocol — door-to-CTA under 40 min
- Interactive ASPECTS calculator — Barber 2000
- CT expansion signs and occlusion site

Step 4 — EVT Eligibility
- Standard window 0–6h
- Extended window — DAWN, DEFUSE-3 criteria
- Large core — ANGEL-ASPECT, SELECT-2

Step 5 — IVT Bridging
- Alteplase vs tenecteplase — EXTEND-IA TNK
- Contraindications to IVT
- Direct EVT vs bridging evidence

Step 6 — EVT Procedure
- Anaesthesia — SIESTA trial, conscious sedation vs GA
- Access and technique — aspiration vs stent retriever
- Intra-procedural decision making