Abstract Details

Title Safety and Efficacy of Endovascular Treatment in the "Hub and Spoke Model"

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 267

Objective

Background BACKGROUND: There are three different pathways for receiving endovascular treatment: primary ED arrival, in-patient, and outside transfer. Each mode has unique attributes that influence the performance and possibly the results of endovascular treatment in acute ischemic stroke patients.

Design/Methods DESIGN/METHODS: We performed a review of acute ischemic stroke patients presenting to our facility who received endovascular treatment from 2004 until 2012. Patient route (ER, inpatient, transfer), rates of poor outcome at discharge (modified Rankin score [mRS] of >3), intracerebral hemorrhages (ICH), as well as patients' clinical characteristics were obtained and analyzed.

Results RESULTS: Among the total 336 patients that underwent IA thrombolysis, 68 patients (mean age 69.1± 16.6; 54% men) were transferred, while 38 patients (mean age 61.1± 14.5; 58% men) were in-patient strokes. Demographics, clinical characteristics, and outcomes are detailed below (Table 1 & 2). The mean admission NIHSS was significantly higher in the transferred patients (16.2± 9.5 versus 15.5± 6.2, p<0.001), though there was no difference in discharge NIHSS. After adjusting for all potential confounders there was no significant difference in good outcomes (odds ratio [OR] 2.0 95% Confidence interval [CI] 0.9-4.3, p=0.06), ICH (OR 0.6 95% CI 0.3-1.3, p=0.2), or mortality (OR 0.6 95% CI 0.3-1.4, p=0.2) between ER patients and transferred patients.

Conclusions CONCLUSIONS: Despite the increased baseline stroke severity, there appears to be no significant risk of increased poor outcomes, ICH, or mortality in acute ischemic stroke patients transferred to endovascular centers. This further justifies the safety and efficacy of the hub and spoke model.

Authors/Disclosures
Wondwossen G. Tekle, MD PRESENTER	Dr. Tekle has nothing to disclose.
Virginia A. Devonshire, MD (UBC Hospital S126)	Dr. Devonshire has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck- Serono. Dr. Devonshire has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis . Dr. Devonshire has received personal compensation in the range of $500-$4,999 for serving as a Consultant for biogen . Dr. Devonshire has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for novartis. Dr. Devonshire has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for roche. Dr. Devonshire has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for biogen .
	No disclosure on file
Ameer Hassan, DO (Valley Baptist Medical Center)	Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.
Saqib A. Chaudhry, MD	Dr. Chaudhry has nothing to disclose.
Steve M. Cordina, MD, FAAN	Dr. Cordina has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Microvention. Dr. Cordina has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech .
Rakesh Khatri, MD, FAAN	Dr. Khatri has received personal compensation in the range of $0-$499 for serving as a Survey consultant with Alpha insight . Dr. Khatri has received personal compensation in the range of $0-$499 for serving as a Survey consultant with Survey company .
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

��ɫ��

��ɫ��