Abstract WP394: Impact of MRI/A versus CTA/P versus Direct Angiosuite Triage Protocols in Stroke Care Performance and Outcome of Transferred Patients for Endovascular Thrombectomy

Abstract

Introduction: Transferred thrombectomy patients face additional time delays that might worsen outcome when compared to direct admission. In 2015, we moved from an MRI/A to a CTA/P protocol to decrease treatment times in transferred patients. In 2017, we initiated a direct admission to angiosuite (DAN) strategy. Herein, we aim to describe procedural and clinical outcomes in transfer patients with acute LVO stroke triaged by these protocols. Method: We reviewed demographics, clot location, and treatment times for all thrombectomies from 2013 to June 2018. Primary outcome was MRS at 90 days. Secondary outcomes were door to groin time, difference between NIHSS at admission and discharge (ΔNIHSS). Distributions are analyzed with Wilcoxon Rank, chi-squared and Fisher’s Exact Tests. Logistic regression is used to evaluate MRS and mortality outcomes and adjusted for clot location, admission NIHSS and tPA use. Results: The analysis includes 178 patients: 25 MRI/A, 130 CT/A/P, and 23 DAN. The groups significantly differ by tPA (16% vs 4% vs 13%, p=0.03), NIHSS at arrival (median 16 vs 17 vs 21, continuous p=0.03) and clot location (ICA 8% vs 20% vs 35%, BA 24% vs 10% vs 26%, p=0.01) for MRI, CT, and DAN respectively. There is significant reduction in median door to groin time between all groups (MRI 170 min., CT 84 min., DAN 16 min., p<0.001). The median ΔNIHSS is significantly different between CT and MRI (10 vs 4, p=0.01) and borderline significant between DAN and MRI (11 vs 4, p=0.07). There is a trend towards decrease disability (MRS 4-5) for DAN patients when compared to MRI at both discharge (OR=0.847, 95% CI 0.18, 4.10) and 90 days (OR=0.38, 95% CI 0.07, 2.10). There is significant increased risk of mortality when comparing DAN and MRI at 90 days (p=0.02). Conclusion: DAN is feasible with faster procedural times and may have clinical benefit in select patients. RCTs are needed to assess the advantages and harm of decreasing imaging in benefit of time.