Abstract T P8: Comparison of Large Vessel Stroke Patient Outcomes Before and After Initiation of On-Site Endovascular Stroke Treatment Services

Abstract

Rational: Availability of an on-site endovascular program for large vessel stroke decreases the time to acute treatment. Since expanding our program to a Manhattan hospital in July 2009, we have seen a decreased time to treatment. We hypothesize that the expansion was associated with improved discharge outcomes in patients with anterior circulation large vessel strokes. Methods: A retrospective chart review of consecutive patients before and after the initiation of the program was conducted. Adults presenting to the hospital with an NIHSS greater than 8, within 6 hours from stroke onset, and with carotid terminus or middle cerebral artery occlusion were included. Exclusion criteria were INR or creatinine >3 and premorbid modified Rankin score (MRS) >1. Comparison was made between the groups before and after initiation of the program. Modified Rankin at discharge was set as a primary outcome. Secondary outcomes included admission-discharge delta NIHSS, discharge disposition, mortality and stroke volume on MRI or CT scan. P<0.05 was set as statistically significant. Results: 70 patients were included in the study. 30 were admitted before July 2009 and 40 after. There was no difference between patient demographics. Only 3/30 patient received endovascular treatment prior to July 2009 versus 34/40 after that. Patients admitted after availability of on-site endovascular treatment were less likely to be dependent (OR: 0.14; 95% CI: 0.019-1) or discharged other than home (OR: 0.233; 95% CI: 0.062-0.876) after adjusting for age and admission NIHSS. In addition there was a significant increase in median admission-discharge NIHSS change in patients treated after July 2009 (p=0.007). No difference between median stroke volume was observed (66 vs 57.2 cm3; p=0.8) Discussion: For every 30 minutes until reperfusion, the probability of good recovery after a large vessel stroke is decreased by about 10%. Transfer delays may impede or limit the benefit of endovascular recanalization. In the absence of strategic air transportation systems, rapid deployment of an endovascular team might decrease the time to recanalization and improve patient outcomes.