Abstract WP42: Real-world Utilization Of Advanced Imaging Based Patient Selection For Thrombectomy

Abstract

Introduction: Multiple clinical trials support an extended treatment window for thrombectomy for large vessel occlusions (LVO) and the treatment of distal occlusions, leading to increased numbers of patients requiring advanced imaging during acute stroke evaluation. Across hospital systems, there is great variation in advanced imaging protocols for acute stroke patients. The goal of this study is to provide a descriptive analysis of the real-world practices in facilities across the United States. Methods: Acute stroke consultations seen by TeleSpecialists, LLC physicians in the emergency department in 227 facilities (27 states) from July 1, 2021 to December 31, 2021 were extracted from the TeleCare TM database. The encounters were reviewed for age, ethnicity, stroke risk factors, last known normal (LKN), arrival time, thrombolytics candidate, door to needle (DTN) time, advanced imaging, LVO, if Neurointerventionalist (NIR) accepted case, premorbid modified Rankin Score (p-mRS), and NIHSS score. Comparison of baseline characteristics and time benchmarks between advanced imaging group (computed tomography angiography (CTA) with optional CT perfusion (CTP)) vs no advanced imaging group (CT only) was performed. Analysis of the location of the occlusion and of the specific vessels being accepted for intervention was performed. Results: There were 29,187 acute stroke consultations seen with 12,641 (43.3%) receiving advanced imaging. The median DTN time for advanced imaging group was 44 minutes (33, 59) vs 41 minutes (30.5, 54) with no advanced imaging group, p = 0.158. There was a higher NIHSS score and lower p-mRS in the advanced imaging group. Analysis of patients with LVO showed lower DTN times, higher NIHSS scores, lower p-mRS, and shorter LKN to arrival times in the patients accepted for thrombectomy. Majority of cases accepted for thrombectomy were left M1 (31.4%) or right M1 (26.6%) occlusions. A significantly lower percentage of patients accepted for intervention had left M2 (10%) and right M2 (6%) occlusions. Conclusion: Advanced imaging in a large real-world data set of acute stroke patients did not significantly delay DTN times. The ability to maintain DTN times is likely related to thrombolytics being prioritized and a parallel process.