Abstract 105: Impact of the Extended Window Mechanical Thrombectomy on Tele Stroke Call Volume in the Post-DAWN and DEFUSE -3 Era

Abstract

Introduction: Recently, two randomized controlled trials proved the safety and efficacy of mechanical thrombectomy in patients presenting up to 24 hours from symptom onset. While the number of patients receiving mechanical thrombectomy has increased following the publication of the extended time window trials, the literature on acute stroke calls over telestroke is relatively scant. In this study we evaluate the volume of telestroke calls, rate of transfers to the thrombectomy center and MT receipt before and after the extended window MT trials publication. Methods: We interrogated the prospectively collected data from a major telestroke network in Southeast the United States to include patients who received a telestroke consult between January 2015 and July 2019. We compared the demographical and clinical characteristics and the outcomes between patients who presented before and after the publication of the extended window mechanical thrombectomy trials. Results: Total of 7,438 patients were evaluated during the study period. Of those, 3392 were after February 2018. There was no difference in age, race, or sex between the two groups (table 1). Patients in the post extended window group had lower National Institute of Health stroke scale (NIHSS) on presentation (3 vs. 4, P<0.001), had longer symptom-onset to door time (123 vs. 85 min, P<0.001), and were more likely to present with stroke mimics (41% vs. 35.3%, P<0.001).Despite this increase in the number of consults per month (190 vs. 103, P<0.001) in the post-DAWN era, there was similar rates of patients eventually receiving MT (3.9% vs. 3.8%, p=0.849) Conclusion: The number of telestroke consults almost doubled since the publication of the extended thrombectomy trials without increase in the rate of MT receipt. These findings have important operational implications for hospitals implementing telestroke call coverage.