Abstract P285: Thrombectomy Treatment Times Pre-Post Early Activation of Interventional Radiology Team

Abstract

Background: Reducing treatment time for ischemic stroke is crucial. In 2017, an urban Comprehensive Stroke Center (CSC) in the Pacific Northwest (PNW) initiated early activation of the interventional radiology team (Early-IR) based on first responder LAMS’ score of 4 or 5 to improve thrombectomy treatment times (door-to-arterial access times [DTAA]) for acute ischemic stroke patients. Policy efficacy has not been evaluated. Objectives: 1) Compare DTAA times and clinical outcomes pre vs post Early-IR initiation using a multi-state stroke registry. 2) Compare DTAA times and clinical outcomes between the PNW and other CSCs in the same multi-state stroke registry. Methods: Included ischemic stroke patients arrived via emergency medical services from 01/01/2015 to 03/30/2020 at PNW CSC and from 05/15/2017 to 03/31/2020 at five other CSCs. Mann-Whitney U test and multiple linear regression were used to compare DTAA among patients arriving Pre-Early IR vs Post-Early IR at PNW and then to compare PNW vs other CSCs during the Post-Early IR phase. Discharge disposition and ambulation were compared using Pearson’s chi-squared tests. Models were adjusted for admission NIHSS, age, gender, race, IV tPA treatment, comorbidities and medications at admission. Results: A total of 156 PNW patients were included in the primary analysis, 32.1 % (n=50) in the Pre- and 67.9% (n=106) in the Post-Early IR groups. Bivariate analyses showed DTAA was faster Post-Early IR (131 minutes vs 92 minutes, p<.001) and remained faster after adjusting for covariates (B=-.500, p <.001). Early IR did not significantly impact discharge disposition ( p =.620) or ambulation ( p =.995) (Table 1). Comparing the PNW to five other CSCs during the Post-Early IR period showed no significant difference in DTAA or secondary outcomes (Table 1). Conclusion: Early IR decreased thrombectomy treatment initiation times for ischemic stroke patients at the PNW CSC.