Abstract WP269: Shift Towards Earlier Time to Presentation of Ischemic Strokes at a Regional Tele-Stroke Network After Endovascular Stroke Trials

Abstract

Introduction: The presentation of results of endovascular stroke treatment trials at the International Stroke Conference (ISC) in February 2015 was a landmark event in the treatment of acute ischemic strokes. Time to treatment remains the main limiting factor in the success of both endovascular and pharmacological treatment of acute ischemic strokes. This study aims to evaluate if publication of these trials has positively impacted the time to presentation for acute ischemic strokes at a regional tele-stroke network. Methods: Clinical data of all stroke consults from 17 months (October 2013 to February 2015) before, and 17 months (March 2015 to July 2016) after presentation of endovascular trials at ISC 2015 was collected from a prospective regional tele-stroke registry. Trends in time to presentation of acute ischemic strokes in the pre-trials and post-trials period were compared. Results: Prospective data of 7176 consecutive tele-stroke consults is presented. There was a significant increase in proportion of tele-stroke calls for acute ischemic stroke referrals in the post-trials period compared to pre-trials period [2792 (84%) versus 2297 (69%), p=0.002]. On sub-group analysis, this trend was seen in the referrals from urban “in-network” hospitals [p=0.02]. There was no change in the referral pattern from rural “out-of-network” hospitals [p=0.2]. In the post-trials period, there was an increase in the proportion of stroke presentations within 4 1/2 hours “window period” and 4.5 to 12 hours, and a decrease in presentation beyond 12 hours [ 4 ½ hrs: 16% vs. 14%; 4 ½-12 hrs: 36% vs. 33%; >12 hrs: 48% vs. 53%, p=0.009] Conclusions: The advent of landmark stroke trials appears to have increased awareness towards stroke treatment, resulting in higher referrals and earlier time to presentation from urban centers, but not rural centers.