1. How a Stroke Physician can find potentially eligible patients for ACST-2 David Hargroves, Consultant Physician, Clinical Lead for Stroke Medicine, East Kent Hospitals University NHS Foundation Trust. 18 th September 2014 david.hargroves@nhs.net

2. How a Stroke Physician can find potentially eligible patients for ACST-2 ….offer cross sectional imaging to everyone David Hargroves, Consultant Physician, Clinical Lead for Stroke Medicine, East Kent Hospitals University NHS Foundation Trust. 18 th September 2014 david.hargroves@nhs.net

3. Who we are: East Kent Hospitals University NHS Foundation Trust is one of the largest hospital trusts in England, with three acute hospitals and several outpatient facilities across East Kent and Medway (1,118 beds) Who we serve: A population of ~750,000 covering approximately 50% of the county of Kent The challenges we faced A large geographical area ( takes an hour to travel from Margate to Ashford), ageing populations in coastal resorts, three distinct combined stroke units

5. Home Office 24hr. Access to Hyper acute stroke care across East Kent N3 (NHSnet) The Internet Canterbury (Vascular Hub) Margate Ashford Patient presented in A&E with symptoms of stroke Nurse calls consultant for remote assessment Doctor on call uses laptop connected to the internet to see live video of patient with two-way audio Solution available from PC’s within Trust Any “high speed” internet connection e.g. Broadband, 3G

6. Early Diagnosis Luminal intervention TIA clinics Hyper acute Care Neurosurgery Social service Early supportive discharge Organised Stroke care Research and Education Primary Care Palliative Care 1° Prevention TIA clinics Neuroradiology Acute Treatment Luminal intervention RACE / stenting Neurosurgery Rehabilitation 2° Prevention ESD / ICT Social service Prolonged Neurorehabilitation Neuro psychology Palliative Care Reviews

7. TIA Clinics: –Daily clinics upon all sites – 1 at weekends –MRI head with DWI and CEMRA neck available for all patients; 8/day –CTA and Doppler second line modality –Monthly MDM to discuss all asymptomatic patients

9. R ICA stenosis 90%

10. Clinical diagnosis confirmed Imaging reviewed Agreement as to asymptomatic nature (>6/12 post symptoms) and life expectancy Compatibility for stenting and surgery ascertained Physician and surgeon assessed Approached in clinic setting ref inclusion in ACST-2 MDM: ‘ no patient to be offerred intervention without consideration for ACST-2’

11. Summary: Research focused ‘A commitment to answering the question’ Collaboration: physicians / surgeons / IR Systems based approach: –All significant stenosis identified sent for review –Monthly governance MDM to discuss all cases before asymptomatic intervention via ACST-2

12. David Hargroves, Consultant Physician, Clinical Lead for Stroke Medicine, East Kent Hospitals University NHS Foundation Trust. david.hargroves@nhs.net Thank you