Abstract
Objective: To highlight the distribution of acute ischemic strokes (AIS) after implementation of endovascular guidelines. Background: Louisiana Emergency Response Network (LERN) is an organization with a mission to build comprehensive statewide systems of care for time-sensitive conditions including stroke. Four levels of stroke centers were recognized in 2013. Level 1: Comprehensive stroke center; Level 2: Primary stroke center; Level 3: Acute stroke ready hospital and Level 4: Non-stroke hospitals. As of 2017, there are 2 comprehensive stroke centers in Louisiana and 15 primary stroke centers. Statewide education was provided regarding mechanical endovascular recanalization (MER) for large vessel occlusion (LVO) in AIS as AHA/ASA guidelines were updated in 2015. Design/Methods: Louisiana hospital inpatient discharge database for year 2014 and 2015 was retrospectively analyzed. Distribution of AIS and MER based on hospital level were explored. Results: A total of 9396 patients with AIS were identified in dataset for year 2014 and 10409 for the year 2015. Proportion of AIS treated in Level 1, 2 and 3 hospitals increased in 2015 {Level 1: 2014 VS 2015: 1034 (11%) VS 1342 (13%); Level 2: 3946 (42%) VS 5035 (48%); level 3: 3195 (34%) VS 3610 (35%)}. Proportion of AIS patients in level 4 hospitals declined in 2015 {Level 4: 2014 VS 2015: 1221 (13%) VS 422 (4%)}. In 2014, 8.2% (770/9396) received any form of recanalization therapy compared to 9.5% in 2015 (989/10409), with higher proportions in Level 1 (22.2% VS 26.2%) and 2 centers (9.4% VS 10.2%) than Level 3 (4.1% VS 3.2%) and 4 (2.6% VS 1.4%). In 2015, 1.8% of patients with AIS had MER; this compares to 0.8% in 2014. Conclusion: The reduction of patients treated in Level 4 hospitals in 2015 suggests our pre-hospital destination protocol facilitated transport to appropriate facilities. The proportion of patients with AIS receiving any form of recanalization increased in 2015, specifically in Level 1 and 2 centers. Improved destination of acute stroke patients likely contributed to increased recanalization rate and utility of MER. Statewide implementation of a revised initial destination protocol respecting the endovascular guidelines should lead to more LVO AIS patients receiving MER.
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