Abstract TP23: Safety and Outcome of Endovascular Therapy in Patients With Minor Stroke: Florida Puerto Rico Collaboration to Reduce Stroke Disparities Study

Abstract

Background: Patients with minor ischemic stroke were largely excluded from the randomized trials of endovascular therapy (EVT) in stroke. In the Florida-Puerto Rico Registry we sought to determine the utilization of EVT in this population. Methods: From January 2010 to March 2017, 57,750 acute ischemic stroke patients within 24 hours of symptom onset were prospectively included from 88 sites in four Florida regions (south, west central, north and panhandle, east central) and Puerto Rico. Differences between minor (NIHSS ≤ 5) and moderate/severe (NIHSS>5) stroke patients who received EVT were evaluated using multivariable logistic regression with generalized estimating equations. Results: Among 2,845 EVT patients (50% women, mean age ±SD 71±14 years), 347 (12%) had NIHSS ≤ 5. As compared to NIHSS>5, minor stroke patients were younger (mean age 67 vs. 71, p<0.01), more men (58% vs. 49%, p=0.01) more privately insured (47% vs. 35%, p<0.01), having more HTN (69% vs. 63%, p=0.03) and prior strokes (25% vs. 20%, p=0.02) but less atrial fibrillation (25% vs. 38%, p<0.01). Minor stroke EVT patients arrived later to the hospital (median 128 vs. 102 min, p=0.02) and during working hours (51% vs. 46%,p=0.09). They were less likely to receive IV tPA (29% vs. 42%, p<0.01), had a longer door to puncture time (median 192 vs. 128 min, p<0.01). In multivariable analysis, young age (OR=1.02, 95%CI 1.01-1.03), early arrival (OR=1.64, 95% CI 1.15-2.33) and FL regions (south vs. west central) (OR=2.67, 95% CI 1.07-6.62) were independently associated with EVT in minor stroke. Symptomatic ICH occurred in 4.6% of minor stroke EVT patients and 6.4% in those with NIHSS>5. Majority of minor stroke patients who received EVT were discharged home or to rehab (75%) while 53% of those with NIHSS>5. Conclusions: More than 1 in 10 cases that received EVT had mild neurological symptoms. Many factors including hospital expertise and time of presentation affect the use of this treatment. Further study of EVT in minor stroke is warranted.