Abstract Details

Title Stroke Outcomes and Palliation in Interhospital Transfer Thrombectomy Candidates with Large Vessel Occlusion Following Extension of the Interventional Treatment Window

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-012

Objective

To assess outcomes and palliative care utilization in acute ischemic stroke (AIS) patients eligible for thrombectomy after interhospital transfer before and after the extension of the acute treatment window.

Background In 2018, the American Heart Association implemented into their guidelines findings from the DAWN and DEFUSE3 trials which extended the window for acute endovascular therapy (EVT) from 6 hours after last-known-well (LKW) to 24 hours.

Design/Methods Retrospective chart review of AIS patients transferred to Mayo Clinic Florida from 01/01/2017 to 04/01/2019 for consideration of EVT. Primary outcomes include time to intervention, in-hospital mortality, palliative and hospice referral rates, 30-day mortality, and 90-day modified Rankin Scale (mRS) score.

Results One hundred thirty-five AIS patients were transferred to our facility for consideration of EVT from 01/01/2017 – 04/01/2019. Fifty-eight were transferred before the extended window and 77 were transferred after. There was an increase in time to EVT from LKW (6.4 hours in the former group vs 10.6 hours in the latter; p = 0.001). However, there was no difference in NIHSS on discharge (10.44 vs 9.69; p = 0.610), length of stay (6.3 days vs 6.4 days; p = 0.898), in-hospital mortality (6.9% vs 10.4%; p = 0.365), percentage of palliative care (8.62% vs 10.39%; p = 0.365) and hospice referrals (15.52% vs 15.58%; p = 0.496), 30-day mortality (18.52% vs 31.43%; p = 0.052), or 90-day mRS (3.76 vs 3.69; p = 0.874).

Conclusions Extending the treatment window for mechanical thrombectomy in AIS from 6 to 24 hours has not significantly impacted the investigated outcomes in our patients. Although there was a trend toward increased 30-day mortality, this did not reach statistical significance. There was no change in utilization of palliative or hospice services. This should increase our confidence in treating AIS patients in the extended treatment window.

Authors/Disclosures
Christopher Kyper, MD (Penn Medicine Lancaster General Health) PRESENTER	No disclosure on file
Melanie R. Greenway, MD (Novant)	No disclosure on file
Maisha T. Robinson, MD, MS, FAAHPM, F�鶹��ýӳ�� (Mayo Clinic)	Dr. Robinson has received publishing royalties from a publication relating to health care. Dr. Robinson has received publishing royalties from a publication relating to health care. Dr. Robinson has received personal compensation in the range of $500-$4,999 for serving as a Longitudinal Knowledge Assessment Question Approval Committee for the Hospice and Palliative Medicine MOC with American Board of Internal Medicine. Dr. Robinson has received personal compensation in the range of $500-$4,999 for serving as a Neuro SAE question writer with �鶹��ýӳ��. Dr. Robinson has received personal compensation in the range of $500-$4,999 for serving as a Guest Editor with Continuum. Dr. Robinson has a non-compensated relationship as a IDEAS Committee Member with American Neurological Association that is relevant to �鶹��ýӳ�� interests or activities.
Josephine F. Huang, MD	Dr. Huang has nothing to disclose.

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