Abstract T P17: Intra-arterial Therapy In Patients With In-hospital Ischemic Strokes Have More Frequent Early Improvement Than Out Of Hospital Strokes

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Background: Stroke is a major complication of many hospital related procedures and prolongs hospital stay. In-hospital stroke alerts provide a unique opportunity to reduce time to treatment, and may be associated with greater chance of neurologic improvement. Objective: To assess outcomes of patients undergoing intra-arterial stroke treatment (IAT) who were originally admitted for a non-stroke diagnosis to the hospital. Methods: A retrospective analysis of stroke patients who qualified for IAT between 7/10/06-6/6/14 was performed. Variables measured included demographics, time to tissue Plasminogen Activator (tPA), time to cerebral angiogram and recanalization, and admission and discharge National Institute of Health Stroke Scale (NIHSS), and pre-treatment core infarct volume by MRI diffusion weighted imaging. Outcome measure was early major improvement of NIHSS≥8 points between pretreatment baseline and discharge. Unadjusted associations were calculated for demographics, time to intervention, stroke severity, stroke volume, hemorrhagic transformation (HT), and outcome measures between in-hospital strokes (IHS) alerts versus out of hospital strokes. An adjusted model was created using variables reaching significance in univariable analysis and those likely to affect outcome. Results: A total of 271 patients underwent IAT during the specified period. These included 47 (17.3%) IHS patients. Mean age was similar in both groups. Median NIHSS at onset of stroke was the same (16, p=0.6), while median discharge NIHSS showed trend towards lower scores in the IHS group(6 vs 12, p0.09). Intravenous thrombolysis was administered less frequently to IHS group (15.2% vs 38.9%; p<0.05). Time to treatment showed a trend towards shorter times for IHS (IV tPA, median 1h:47m vs 2h:15m, p0.13; time to recanalization, median 4h:10m vs 7h:23m, p0.25). In our adjusted model, in-hospital stroke (OR 4.75, CI1.2-19.1), IV thrombolysis (OR 2.4, CI 1.1-6.0), pretreamet core infarct volume (unit OR 0.98, p=0.03), and HT (OR 0.29, p=0.01) were independently associated with an NIHSS improvement of ≥8. Conclusion: Patient developing acute stroke during their hospital stay who undergo IAT have higher chance of early neurologic improvement.