The study objective was to describe contraindications for IAT.

All patients with suspected stroke receive imaging to assess the need for intra-arterial therapy (IAT). Only patients diagnosed with an ischemic stroke and neuroimaging suggesting large vessel intracranial occlusion are treated with IAT. Hospitals with IAT capabilities are scarce, therefore many patients are transferred to comprehensive stroke centers for IAT. At times transfer patients do not receive IAT and transferring facilities inquire the reason why. Therefore, our group modified a field in the stroke registry to more descriptively track contraindications for IAT.

All adult patients (age ≥ 18 years old) admitted from 10/2018 to 3/2019 with an ischemic stroke diagnosis who did not go to IAT were included in this retrospective study. Data are summarized as counts and proportions.

There were 328 patients included. Twenty-three percent (75) were transfer patients. The median age was 70 and 52% were male. The most common IAT contraindication for both direct admissions and transfer patients was no thrombus on CTA (60% and 67% respectively). Of the patients who had no thrombus on CTA, 37% (25) received tissue plasminogen activator (tPA). Thirteen percent (34) patients directly admitted and 12% (9) transfer patients were not salvageable due to ischemia. The thrombus was too distal for intervention in 4% (11) of directly admitted and 1% (1) of transfer patients.

The most common contraindications for IAT were that there was no thrombus on CTA, or the patient was not salvageable due to ischemia. CTA imaging showing that there is no thrombus could be useful as an exclusion criterion for transferring patients to a comprehensive stroke center for IAT.