Abstract 114: Spoke-administered Thrombolysis Improves Large Vessel Occlusion Early Reperfusion And Inter-hospital Transfer Time For Mechanical Thrombectomy In A Hub-and-spoke Telestroke Network.

Abstract

Introduction: The utility of intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke is controversial. Low early recanalization (ER) rates and potential delays to MT may support bypassing IVT before MT. Recent trials suggest MT alone is reasonable for LVO patients presenting directly to MT-capable centers. However, bypassing IVT has not been evaluated for patients first presenting to “spoke” hospitals capable of administering IVT but requiring transfer to a “hub” hospital for MT. Here we examined how spoke IVT influences LVO ER and spoke-to-hub transfer time (TT) within our hub-and-spoke network. Methods: Patients presenting to 25 spoke hospitals before hub transfer from 2018 to 2020 who were considered possible EVT candidates with pre-transfer CTA-defined LVO and ASPECTS ≥6 were identified from a prospectively maintained database. ER was determined by chart review of vessel imaging on hub arrival. TT was prospectively recorded. Statistics were performed using permutation resampling and linear regression in R. Results: Of 177 patients included, 76 received IVT. Baseline characteristics, NIHSS, and intracerebral hemorrhage were similar between groups. Spoke IVT improved ER frequency [12/76 (15.8%) vs. 3/101 (3.0%), P<0.0001]. Further, spoke IVT was associated with improved ER (aOR=5.9, 95% CI=1.3,33.7, p=0.02), independent of last known well. Patients receiving IVT had decreased mean TT by 25 minutes (139±59 min vs. 164±71 min, p=0.01). Patients with ER had NIHSS interval improvement from spoke to hub [median -2 (IQR 0.0, -3.5) vs. 0 (1.0, -0.4), p=0.02]. IVT was associated with improved 90d mRS ≤2 independent of age, NIHSS, and MT treatment (OR=2.5, 95% CI=1.1, 6.1, p=0.04). Conclusion: Within our network, IVT significantly increases ER and decreases TT, which may contribute to improved 90-day outcomes. This retrospective study supports following current recommendations that IVT be given to all eligible patients at spoke hospitals prior to transfer for MT consideration.