ABSTRACT NUMBER: ESOC2026A2456 RIGHT PATIENT, RIGHT HOSPITAL, FIRST TIME: EARLY EXPERIENCE OF A 'DIRECT TO THROMBECTOMY' PATHWAY USING VIDEO TRIAGE IN LONDON

Abstract Background and aims In London, hyperacute stroke patients are conveyed to the nearest hyperacute stroke unit (HASU). However, not all HASUs provide mechanical thrombectomy (MT), and interhospital transfer may delay treatment. Since September 2024, a ‘Direct to Thrombectomy’ pathway using prehospital video triage (PHVT) has enabled identification of potentially MT-eligible patients and direct transfer to a thrombectomy-capable HASU. Methods We prospectively evaluated the first 10 consecutive patients via this pathway. Key time metrics included onset-to-PHVT, PHVT-to-hospital arrival, and arrival-to-thrombolysis, thrombectomy, or intracerebral haemorrhage (ICH) bundle care. Results All patients underwent consultant-led decision-making with forward handover. Nine were transferred to an MT centre, all with confirmed ischaemic stroke, while one was transferred to the nearest HASU for suspected, and subsequently proven, ICH. Median onset-to-PHVT time was 141.5 minutes (IQR 49.5–332.5), PHVT-to-arrival 46.5 minutes (IQR 34–56.5), and arrival-to-scan time 16.5 minutes (IQR 14–19.75). Six patients (66%) underwent MT, and five received thrombolysis. Median door-to-needle time was 44 minutes (IQR 31.5-64.5), door-to-groin time 95 minutes (IQR 78.8-183). For the ICH, door-to-anticoagulation reversal was 124 minutes, and door-to-blood pressure control was 241 minutes. Three patients did not undergo MT due to revised pre-morbid status, M2 occlusion and non-occlusive M1 stenosis, respectively. Comparative median door-in–door-out time was 72 minutes (IQR 58-92) at the closest thrombolysis-only HASU. Conclusions Our review showed that the protocol for decision-making was followed, and the correct pathway decision was made in each case, leading to the shortest possible times to time-critical treatment. Ongoing evaluation is required to assess clinical outcomes and cost-effectiveness. Conflict of interest Chak Lam Ip: nothing to disclose. Jonathan Hayton: nothing to disclose. Selina Edwards: nothing to disclose. Sohaa Jamil: nothing to disclose. Ken Crossley: nothing to disclose. Rajaram Bathula: nothing to disclose. Sohaa Jamail: nothing to disclose. Salman Haider: nothing to disclose. Jonathan Best: nothing to disclose. Soma Banerjee: nothing to disclose. Rob Simister: nothing to disclose. Figure 1 - belongs to Conclusions