Abstract WP386: tPA Treatment for Patients Found to Have Stroke Mimic is Similar Among Neurovascular Fellows and Attendings

Abstract

Introduction: Neurovascular fellows (NVFs) may need formalized telemedicine (TM) training to prepare for increasing acute ischemic stroke (AIS) coverage needs. TM assessment of stroke mimics (SM) can be challenging given physical barriers. We evaluated for differences between NVF and neurovascular attending (NVA) AIS management for patients who receive tPA but are found to have SM. Methods: We identified patients in our TM stroke registry (9/2015-12/2017) who received tPA for suspected AIS. We compared frequency of tPA treatment for SM patients between NVFs and NVAs. We also compared baseline patient characteristics and outcomes post-tPA. Results: Of 693 patients who received tPA for suspected AIS over TM, 16.6% had a final diagnosis of SM. NVFs evaluated 12.2% of tPA treated patients. 16.5% of the 85 tPA-treated patients seen by NVFs were found to have SM, compared to 16.6% of the 608 tPA-treated patients seen by NVAs. There were no differences in characteristics among SM patients including age, gender, race/ethnicity, comorbidity and stroke severity (Table 1). Adverse effects after tPA for all SM patients were minimal. More patients had good mRS at 90 days after NVF assessment, however this may be limited by the small number of patients treated by NVFs. Time to treatment was similar among NVFs and NVAs (Table 2). Conclusion: While differences have been demonstrated in TM management of AIS between NVFs and NVAs, they appear to evaluate SM vs AIS similarly. Our findings support the safety of integrating TM training during fellowship, and provide direction for educational efforts.