LAUSR

In the modern era of stroke care, the clock is always ticking. We are all aware of the need to act ‘FAST’ to maximise the chance of a patient having a good outcome. ‘Time is brain’ is the mantra for delivery of thrombolysis and time to puncture is a nationally audited marker for thrombectomy care. However, for a variety of reasons, there can be delays in a patient reaching an interventional stroke centre. Some are outside of our control, for example, patients with an unknown onset time of their stroke. Others are within our control, such as basilar strokes that are demonstrably repeatedly missed clinically. Finally, unlike trauma we do not yet have the tight network infrastructure for rapid transfer of patients to an interventional stroke centre. What should we do for patients who fall outside clear trial-based National Institute for Health and Care Excellence (NICE) guidelines? Thrombectomy within 12 hours for acute ischaemic stroke caused by anterior circulation large vessel occlusion dramatically changes functional outcomes for patients, with a number needed to treat to reduce disability by one point on the modified Rankin Scale score for one patient of 2.6.1 Such impressive outcomes make it tempting to …