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