Abstract T MP60: Limited Role for Neurosurgical Hematoma Evacuation for Post-Alteplase Ischemic Stroke Patients: Impact on the Role of Neurosurgical Coverage for Primary Stroke Patients

Abstract

Introduction: Hemorrhage is a well documented consequence after the administration of intravenous alteplase (IV-tPA) in the therapy of ischemic stroke. Serious intracranial bleeding may occur in 6.4 percent of patients within thirty-six hours. Primary stroke centers certified by The Joint Commission (TJC) require neurosurgical coverage or transfer protocols to ensure neurosurgical services are available within two hours. Hypothesis: We assessed the hypothesis that patients receiving IV-tPA for ischemic stroke would not require any type of neurosurgical intervention within two hours. Methods: Ischemic stroke patients who received IV-tPA from January 2010 to June 2013 across 11 hospitals with a regional stroke network were analyzed retrospectively. Of those patients we assessed the prevalence of brain hemorrhage, and further the need for neurosurgical intervention (craniotomy, craniectomy, burr-hole placement, extraventricular drain (EVD) placement) during that inpatient admission. Results: Of the 17,319 inpatient admissions in our regional stroke network, 6,500 patients were admitted for ischemic stroke. Only 2% of all patients treated with IV-tPA had symptomatic brain hemorrhages (10/520). One patient underwent craniotomy for hematoma evacuation after an observation period of six hours (0.2%; 1/520). Conclusions: Symptomatic brain hemorrhage after IV-tPA requiring emergent neurosurgical intervention is rare. The results of this study underscore the relevance of transfer protocols to ensure neurosurgical services are available within two hours but question the need for neurosurgical coverage at designated primary stroke centers.