Abstract TP460: Recognizing Large Vessel Occlusions Earlier in the Stroke Alert Process

Abstract

Background: As an Agency for Healthcare Administration (AHCA) Comprehensive Stroke Center we were looking for ways to decrease our door to groin puncture time for patients that had Large Vessel Occlusions (LVO) requiring mechanical thrombectomy. We found patients were often making two trips to the CT scanner. First for their plain brain CT to rule out blood and then for a CT Angiogram and CT Perfusion scan if it appeared the patient was having a Large Vessel Occlusion (LVO). Our mean groin puncture time for mechanical thrombectomy was 116 minutes in 2015. Purpose: To recognize the signs and symptoms of a LVO and save time by completing the plain brain CT scan, the CT Angiogram, and the CT Perfusion scan on the same trip to the CT department. Method: Our vascular neurologist reviewed the signs and symptoms of Large Vessel Occlusions utilizing V.A.N. (vision, aphasia, neglect) criteria with the Emergency Room Physicians, the Emergency Room Nurses, the Clinical Resource Nurses as well as all Emergency Medical Services (EMS) personnel. Lectures were given as well as hands on demonstrations. Telemedicine was asked to see the patient upon arrival in the ambulance bay to observe for LVO as well. Mock codes were run on both campuses with success. Results: Initially all stroke alerts were getting CT Angiograms and CT Perfusions completed regardless of whether they were VAN positive. However, after we reviewed all the false positives the number of patients actually getting these scans decreased to those that truly needed them. EMS now feels comfortable and competent calling LVO’s in the field. As do the Emergency Room physicians. As a result of these patients getting their required scans in one trip to the CT department, our door to groin puncture time has decreased from 116 minutes to a mean of 56 minutes. Conclusion: In conclusion, we found that adopting the utilization of VAN criteria to recognize LVO’s has decreased the mean door to groin puncture time for mechanical thrombectomy allowing for sooner return of circulation to the brain and improving patient outcomes.