Abstract WP5: Bundling Of Head Computed Tomography Scan And Head And Neck Computed Tomography Angiogram At Initial Telestroke Consultation Is Associated With Faster Thrombectomy Transfer And Treatment Times

Abstract

Introduction: Telestroke has expanded access to tPA and thrombectomy for acute ischemic stroke and improved neurologic outcomes. A key step in the evaluation of acute stroke is non-contrast head CT (HCT) and head and neck CT angiogram (CTA). These imaging studies can either be bundled at presentation, or a delayed CTA may be performed after a tPA decision based on HCT alone. Bundled imaging may facilitate faster transfer and treatment times, while delaying tPA. We investigated the effect of bundled imaging on thrombectomy transfer and treatment times in our telestroke network. Methods: We reviewed patients in our telestroke network from 2019-2021. We included patients who had received HCT and CTA at a partner hospital prior to transfer to our comprehensive stroke center (CSC) for thrombectomy. We collected baseline clinical variables, and timing of imaging, transfer and treatment relative to time of initial HCT. Patients were divided into a bundled imaging group (simultaneous HCT and CTA) or a delayed CTA group. Wilcoxon Rank sum test was used to compare between the two groups for HCT to tPA needle time, HCT to CSC arrival time, and HCT to Groin Puncture Time Results: 273 patients were assessed via telestroke in the study period. Of these 93 were included. 43 patients received bundled CTA, and 50 patients received a delayed CTA. 20 patients received tPA in the bundled group vs 25 in the delayed CTA group. Median CSC transfer time was lower with a bundled imaging strategy (110 min vs 160 min; p<0.001), as was median time to groin puncture (174 min vs 242 min; p<0.001). Further, there was no difference in tPA needle time (38 min vs 37 min; p=0.86). Conclusions: Bundled HCT and CTA at telestroke sites was associated with significantly faster transfer and groin puncture times for patients with large vessel occlusion. Further, obtaining the CTA prior to a tPA decision did not significantly prolong HCT-to-needle times.