Abstract TP307: Clinical and Neuroimaging Criteria to Improve Transfers to Comprehensive Stroke Centers for Endovascular Reperfusion Treatment Evaluation

Abstract

Transfer protocols from primary (PSC) to comprehensive stroke centers (CSC) are crucial for the success of endovascular treatment (EVT). We aimed to identify clinical and neuroimaging predictors of EVT outcome in patients first assessed at non-capable EVT centers. Methods: Retrospective analysis of consecutive patients included in a prospective, population-based, mandatory registry of acute ischemic strokes (AIS). Inclusion criteria: AIS firstly evaluated at a PSC with suspected large vessel occlusion (LVO) transferred to a CSC for EVT assessment. PSC and CSC-ASPECTS, time-metrics and clinical data were analyzed. Results: Between February 2016 and May 2018, 1185 EVT candidates were transferred from PSC to CSC in our stroke code network (see Graph). Median baseline NIHSS was 13(7-19). 53.4% received iv tPA in the PSC. Upon CSC arrival, LVO was confirmed in 63.1% patients, and 42.8% received EVT. After a median of 130(107-169)min between both CT-acquisitions, the median inter-facilities ASPECTS decay was 1(0-2) and only 11.9% showed a CSC-ASPECTS<6. A ROC curve identified baseline NIHSS>16 as the best cut-off point that predicted CSC-ASPECTS<6(Sensitivity 67%, specificity 75%, AUC 0.7). A logistic regression analysis adjusted by age, time from symptoms to PSC-CT and time from PSC-CT to CSC-CT showed that only a baseline NIHSS>16 independently predicted a CSC-ASPECTS<6(OR 3.8, CI 2.1-6.9, p<0.001). The rate of CSC-ASPECTS<6 increased to 21% among AIS with NIHSS>16, and to 38.1% in patients with NIHSS>16 and PSC-ASPECS≤7. Conclusion: ASPECTS<6 scores are uncommon in CSC even after long transfer times. Except for selected cases (NIHSS>16 or PSC-ASPECTS≤7), confirming ASPECTS upon CSC arrival may not be necessary among AIS transferred from PSC.