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Clot retrieval and acute stroke care

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Resource distribution in stroke care must be rational and evidence-based, not driven by media coverage

There has been a sudden upsurge of interest in the availability of endovascular clot retrieval (ECR) for stroke treatment (Box). Recent newspaper articles published in New South Wales1,2 highlight the potential benefits as well as the financial and logistical challenges of providing around the clock ECR services in a vast country like Australia.

Many well designed randomised trials have demonstrated the efficacy and safety of ECR,3 but the evidence of benefit, although dramatic in some cases, is confined to patients whose ECR procedure begins within 6 hours of symptom onset,4 with or without intravenous thrombolysis. However, before 24/7 ECR services can operate in Australia, individual health services need to examine the challenges of transporting eligible stroke patients from the emergency departments wherever they may be — remote, regional or urban — to a comprehensive stroke centre within the required time window. This potentially means covering vast distances — several hundreds of kilometres in some cases — in a matter of hours. A detailed analysis then needs to demonstrate that the benefits of a rapid ECR service…