Multi-Modal CT Delays Initiation of Intravenous rt-PA for Acute Ischemic Stroke (P07.023)

Abstract

Objective: The purpose of this study was to identify predictors of intravenous rt-PA treatment delays in our comprehensive stroke center. Background Timely administration of intravenous rt-PA improves outcomes after acute ischemic stroke. Guidelines endorse rt-PA treatment in eligible patients within 60 minutes of emergency department (ED) arrival. Design/Methods: We retrospectively identified consecutive acute ischemic stroke patients who received intravenous rt-PA over 8 months. Time intervals from ED arrival to neuroimaging and treatment with rt-PA were calculated. Door-to-needle (DTN) time was defined as the interval from ED arrival to initiation of rt-PA treatment. Patients with DTN times ≤ 60 minutes were compared to those with DTN times > 60 minutes using the Student9s t-test for continuous variables and Fisher9s exact test for categorical variables. Results: 18 /154 (11.7%) patients diagnosed with acute ischemic stroke were treated with rt-PA. In the overall treatment cohort, the mean age was 68.7±20.3 years, 44 % were male, and baseline NIHSS ranged from 1- 31. The mean DTN time was 67±34 minutes and 10/18 (56%) had DTN time ≤ 60 minutes. Patients with DTN times > 60 minutes were older (mean age 79 vs.61; p=0.05) and more likely to undergo multi-modal CT imaging (75% vs. 20%; p=0.05) prior to administration of rt-PA. The mean DTN time in those patients who underwent multi-modal CTA was 88±38 minutes vs. 50±17minutes in those who did not undergo multi-modal CTA (p=0.01). No significant differences in baseline stroke severity, time of day, day of week or time from symptom onset to ED arrival were observed between the two groups. Conclusions: In our comprehensive stroke center, performance of multimodal CT in patients eligible for intravenous rt-PA was associated with treatment delays. The diagnostic value of CTA and CTP should be carefully considered in acute ischemic stroke patients who present within 3 hours of symptom onset. Disclosure: Dr. Singh has nothing to disclose. Dr. Raper has nothing to disclose. Dr. Mooney has nothing to disclose. Dr. Shaw has nothing to disclose. Dr. Meschia has nothing to disclose. Dr. Barrett has nothing to disclose.