Abstract TP49: Visual Review Of Neuroimaging Prior To Transfer Acceptance Is Significantly Associated With Higher Rates Of Endovascular Therapy

Abstract

Background: With the advent of extended window endovascular therapy (EVT) for acute ischemic stroke (AIS), interhospital transfer is increasingly frequent. However, not all patients who are transferred undergo EVT. To use resources judiciously, stroke centers need to identify which patients are most likely to benefit from EVT prior to transfer. Methods: We performed a retrospective study of AIS patients transferred for potential EVT at our neurovascular center between 2015 and 2018. We noted whether pre-acceptance imaging was available for visual review on LifeImage, RAPID perfusion software, or Telestroke PACS. The primary outcome was EVT on arrival. Results: 530 AIS patients were included. 270 underwent EVT (50.9%); 156 (29.4%) had pre-acceptance imaging reviewed; 275 (51.9%) received IVtPA. Of all patients who were transferred, performance of pre-transfer CTA was significantly associated with EVT (57% vs 40%, p<0.001). Review of any pre-acceptance imaging was significantly associated with EVT in patients who did not recanalize by the time of arrival (67% vs 53%, p=0.006) and in those who did not receive tPA before transfer (68% vs 49%, p=0.003). Review of imaging via perfusion software was significantly associated with EVT in patients who did not recanalize prior to arrival (69% vs 54%, p=0.009) and in those who did not receive tPA (72% vs 50%, p=0.002). Conclusions: Pre-acceptance visual review of imaging by accepting team, in particular via perfusion software, was significantly associated with likelihood of EVT in patients who did not receive IVtPA and/or who did not recanalize by time of arrival. Performance of CTA at outside hospital prior to transfer (regardless of imaging review) was associated with likelihood of EVT. Type of imaging performed and ability for accepting team to review imaging prior to transfer acceptance may help improve interhospital transfer resource utilization.