Abstract Details

Title Differences in Presentation and Treatment Times of Patients With Large Vessel Occlusion

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (12:00 PM-1:00 PM)

Poster/Presentation
Number 4-003

Objective We analyzed presentation and treatment times of patients with large vessel occlusion (LVO) of the left hemisphere (LH), right hemisphere (RH), and basilar artery (BA) at an urban, comprehensive stroke center (CSC).

Background Presenting symptoms likely impact time to recognition and treatment in acute ischemic stroke (AIS). Limited data suggest that RH patients experience delays to admission and are less likely to receive endovascular therapy (ET) at low NIHSS scores than LH patients. Such data on laterality in LVO stroke are lacking.

Design/Methods We conducted a retrospective review of consecutive AIS patients with LVO from 2017-2018. Primary outcome was time from last known well (LKW) to arrival (door), by distribution. Secondary outcomes included door to CT time for all patients and door to needle (DTN) or door to groin puncture (DTG) times for patients treated with revascularization therapy.

Results Of 264 with LVO, 42.0% (n=111) had LH, 37.1% (n=98) RH, and 4.2% (n=11) BA LVO. 8.1% (n=9) LH, 11.2% (n=11) RH, 18.2% (n=2) BA LVO were treated with intravenous alteplase and 58.6% (n=65) LH, 52.0% (n=51) RH, 90.9% (n=10) BA LVO were treated with ET. Median LKW to door was 291 (IQR:187-715), 317 (IQR:186-831), and 311 (IQR:194-961) minutes for LH, RH, and BA LVO, respectively. Median door to CT order was 8 (IQR:4-16), 8 (IQR:4-16), and 16 (IQR:4-179) minutes for LH, RH, and BA LVO, respectively. Median DTN was 51 (IQR:38-56), 50 (IQR:30-77), and 100 (IQR: 14) minutes for LH, RH, and BA LVO, and median DTG was 98 (IQR:70-125), 81 (IQR:64-107), and 126 (IQR:62-411) minutes for LH, RH, and BA LVO.

Conclusions Although patients with LH LVO presented more quickly than RH and BA, LH and RH patients were treated within similar times after arrival. Times to CT and revascularization therapies for BA LVO may be prolonged due to instability at presentation.

Authors/Disclosures
John H. Erdman III, MD (John Erdman) PRESENTER	Mr. Erdman has nothing to disclose.
Laura K. Stein, MD, MPH (Mount Sinai School of Medicine)	The institution of Dr. Stein has received research support from American Heart Association.
	No disclosure on file
Nathalie Jette, MD, MSc, FRCPC, F�鶹��ýӳ�� (University of Calgary)	Dr. Jette has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for ILAE Epilepsia. The institution of Dr. Jette has received research support from NIH. The institution of Dr. Jette has received research support from AES.
	No disclosure on file
Mandip S. Dhamoon, MD, MPH	Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Faegre Baker Daniels LLP. Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Wellstar Health System Inc. Dr. Dhamoon has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Fabiani Cohen & Hall, LLP. Dr. Dhamoon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Kramer, Dillof, Livingston & Moore. Dr. Dhamoon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Robins Kaplan. Dr. Dhamoon has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Parker Waichman LLP. Dr. Dhamoon has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Heidell, Pittoni, Murphy & Bach, LLP.
Parul Agarwal	Parul Agarwal has nothing to disclose.

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