Abstract WP282: Predictors of Candidacy for Endovascular Therapy in Telestroke Patients Transferred to a Comprehensive Stroke Center

Abstract

Endovascular therapy (EVT), with IV tPA if eligible, is the standard of care for large vessel occlusion (LVO) in acute ischemic stroke. Many patients transferred from outside hospitals to comprehensive stroke centers (CSCs) for potential EVT are found to be ineligible. We aimed to determine predictors of EVT candidacy for suspected LVO strokes in patients transferred from telestroke network hospitals within 24 hours of last known normal time. Methods: All adult patients transferred after telestroke consultation to our CSC emergency department with acute ischemic stroke and suspected LVO from November 2017 to June 2018 were retrospectively reviewed. This time frame was chosen due to practice changes following the establishment of an extended EVT time window. Data analyzed included demographics, risk factors, BP, NIHSS, presence of cerebellar signs and cortical signs (i.e., aphasia, gaze palsy, visual field defect, neglect). With EVT candidacy as the dependent variable, stepwise logistic regression was done with the significance level both for a factor to enter and stay in the model set at 0.15. Results: A total of 133 patients (mean age 67.5 ± 16 years, 47.4% women, 85.7% White, 14.3% non-White) were identified. EVT was performed in 36 of 133 patients (27%). The mean NIHSS for EVT patients was 13.1 ± 6.7 compared to 8.5 ± 8.0 for non-EVT patients (p=0.0030). Each unit increase in NIHSS was associated with being more likely to receive EVT (p=0.10). Cortical signs were present in 32 of 36 EVT patients (88.9%) compared to 57 of 97 non-EVT patients (58.8%) (p=0.0010). The presence of cortical signs was associated with receiving EVT (OR 4.60, 95% CI 1.30-16.26; p=0.02). A history of CHF was associated with being less likely to receive EVT (OR 0.31, 95% CI 0.10-1.02, p=0.05). There was a trend toward non-White race being associated with receiving EVT (OR 2.91, 95% CI 0.88-9.62; p=0.08). Conclusion: The presence of cortical signs, more so than the collinear variable of higher NIHSS, was a significant predictor of candidacy for EVT. Non-White race and CHF are variables that will need to be validated in future studies. These findings, combined with further studies, could help telestroke physicians establish improved selection criteria for transfer of stroke patients to CSCs for EVT.