Abstract TP369: Rapid Evaluation of Acute Ischemic Stroke Patients for Intervention

Abstract

Background: Only Primary Stroke Center (PSC) in large metropolitan area implementing RAPID CT-Perfusion (CT-P) software to quickly determine if patients may benefit from endovascular therapy (E.T.) and transfer to a Comprehensive Stroke Center (CSC). Purpose: To rapidly evaluate potential candidates for E.T. utilizing objective criteria via a standardized algorithm and CT-P technology. The goal was to improve assessment of large vessel occlusions and “wake up strokes” increasing practitioner’s confidence in transferring only those patients who may benefit from E.T. Patients who would not benefit from E.T. are confirmed, allowing the PSC to retain those patients, avoiding over-burdening of the CSC, and increasing patient and staff satisfaction. Method: Algorithm developed addressed the eligibility of acute ischemic stroke patients for potential E.T. based on objective criteria. Stroke patients receive CT scan on arrival, are screened for and administered IV Alteplase immediately if eligible. Algorithm is applied and if criteria met, RAPID CT-P study is performed and transmitted to CSC. This software quickly determines the presence of any salvageable penumbra from a large vessel occlusion. The software decreased the decision time from over 60 minutes to less than 8 minutes. At the time the CT-P is done, it transmits the images to the PSC neurologists and the CSC neuro-interventionalists via cellphone or iPad. Results: Objective tools to select appropriate patients for transfer for E.T. From October 2016 to June 2017, 64 patients had the RAPID CT-P. Of 64; 20 were transferred, 19 had intervention, and 44 remained at the PSC. The one transfer that did not receive E.T. had received IV tPA and re-perfused by the time of arrival to the CSC. In conclusion, this process made a significant positive impact on the outcomes of transferred patients receiving E.T. Physicians feel more confident in transferring appropriate patients and offering them E.T. Patients that are not eligible for this therapy are admitted, whereas before they could have been transferred to the CSC and not found not eligible for E.T. This has also led to increased collaboration, satisfaction, and collegiality between the two centers.