Abstract Details

Title A clinical decision tool to evaluate eligibility for endovascular therapy upon transfer within a regional stroke center

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 034

Objective

To develop a clinical decision tool to identify patients at high likelihood of eligibility for endovascular therapy (EVT) upon transfer to a comprehensive stroke center (CSC).

Background

About half of transferred acute ischemic stroke patients who are eligible for EVT at the primary stroke center (PSC) do not undergo groin puncture upon arrival at the CSC. The exact patients’ baseline characteristics predicting groin puncture are unknown.

Design/Methods

We retrospectively reviewed data from consecutive acute stroke patients transferred to a CSC for EVT evaluation within a regional network in Canada, between 08/2015 and 07/2019. Clinical, radiographic and driving distance variables were explored. We performed multivariable logistic regressions and a least absolute shrinkage and selection operator logistic regression modeling with data divided into a derivation (203 patients) and validation cohort (67 patients). The primary outcomes were groin puncture and thrombectomy upon arrival.

Results

Out of 270 transferred acute ischemic stroke patients (mean age 69.4 +/- 13.7, 47.4% female), 201 (74.4%) received groin puncture and 182 (67.4%) received thrombectomy. Positive predictors of receiving groin puncture were onset-to-PSC arrival time (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.06-1.18, p=0.00004), internal carotid artery (ICA) occlusion (OR 2.74, 95% CI 1.42-5.31, p=0.003), and M1 occlusion (OR 2.48, 95% CI 1.31-4.70, p=0.006). The only negative predictor was onset-to-CSC arrival time (OR 0.91, 95% CI 0.87-0.96, p=0.0002). These predictors also applied to thrombectomy. Our groin puncture and thrombectomy models had a C statistics of 0.843 and 0.810 respectively in the derivation cohort, and 0.744 and 0.667 respectively in the validation cohort.

Conclusions

Delays in presentation to the PSC, and ICA and M1 occlusions predicted higher probabilities of groin puncture and thrombectomy, while longer transfer times to CSC was associated with lower probabilities. This prediction model may guide physicians selecting EVT candidates for transfer based on pre-transfer data.

Authors/Disclosures
Bing Yu Chen, MD (Hamilton Health Services) PRESENTER	Dr. Chen has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Wieslaw J. Oczkowski, MD	Dr. Oczkowski has nothing to disclose.
	No disclosure on file
	No disclosure on file
Ashkan Shoamanesh, MD	Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer AG. Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Daiichi Sankyo . Dr. Shoamanesh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Servier Inc.. Dr. Shoamanesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurodiem.ca. The institution of Dr. Shoamanesh has received research support from Servier Canada Inc.. The institution of Dr. Shoamanesh has received research support from Daiichi Sankyo Ltd.. The institution of Dr. Shoamanesh has received research support from Bayer AG. The institution of Dr. Shoamanesh has received research support from Bristol-Myers Squibb. The institution of Dr. Shoamanesh has received research support from Octapharma Canada .
Luciana Catanese, MD	Dr. Catanese has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for IschemiaCare.

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Abstract Details