Abstract WP297: Impact of the Extended Thrombectomy Window on a Large, Comprehensive Stroke Center Run Telestroke Network

Abstract

Background: The Wake Forest (WF) Telestroke Network, founded in 2009, is the largest in North Carolina serving 20 hospitals. WF Baptist Medical Center is a Comprehensive Stroke Center (CSC) and referral site for endovascular therapy from many regional hospitals, including 11 within our telestroke network. In December 2017, following dissemination of the DAWN and DEFUSE trial results, we adopted a 24 hour thrombectomy window at WF. In January 2018, education was provided at telestroke sites to facilitate identification of candidates for extended thrombectomy (ET). It has been unclear how the extended window will impact CSC systems. We evaluated the impact of ET on telestroke calls, transfers, and thrombectomy volumes within our state and regional telestroke network. Method: Telestroke activations and consultations within our state network for the months pre and post ET protocol implementation were compared (July -December 2017 vs January - May 2018). Stroke transfers from regional telestroke hospitals and resultant thrombectomy procedures conducted at WF were compared (July - November 2017 vs December 2017-June 28 2018). Patients transferred for primary hemorrhage were excluded. Monthly volumes were compared using the Kruskal-Wallis Test. Results: Monthly network activations increased, though not significantly, following education on ET window (median 109.5 vs 153 p = 0.07). Monthly consultations remained steady (median 50.5 vs 54 p= 0.20). Stroke transfers per month remained steady (median 28 vs 27 p= 0.74) while thrombectomies increased (median 1 vs 4 p=0.03). Conclusions: Though thrombectomy volumes increased, the impact on telestroke consultations and transfer volumes at our institution has not been substantial since adoption of the 24 hour thrombectomy window. While the ET window has led to more calls to our 20 site telestroke network, likely for triage of later presenting patients, it was not significant in this small sample. Further evaluation will examine this trend. Regional transfers to WF have remained stable, as the majority of patients with large stroke are transferred for inpatient stroke care. With a previously established transfer arrangement, the extended window has not led to overtriage from our regional hospitals.