A retrospective study was performed. Primary outcome measures were neurologic outcome, mortality, and TICI scores. Safety measure was symptomatic hemorrhage rate (SICH; NIHSS > 1 at ≤ 36hr).

From 1/2014-2/2018, 61 of 233 transferred rt-PA patients received MT. For the 233 patients group, median age was 73, median NIHSS 6, SICH rate 4% and discharge mRS≤2 rate 43%. Mean admission NIHSS was 13 and discharge 9. Mortality was 11%; 40% went home.

For the 61 rt-PA + MT patients, SICH rate was 2% and mortality 12%. Greater than 90% had AF.

Independently, 45 of the 233 patients had a pre rt-PA CTA with LVO. In these patients, median time to initial CTA was 77 min, and to repeat CTA 144 min. Of the LVOs, 80% were anterior circulation. Clot migration was seen in 5%. rt-PA recanalization rate was 11%. MT after rt-PA was performed in 65% (TICI ≥ 2b 89%). All patients with symptom onset to initial CTA ≤2 hours achieved TICI 2b or higher, and average time to recanalization was shorter (289 min  vs. 494 min >2h). Average NIHSS declined from 12 to 5 post MT.

Remote LVO IV rt-PA followed by MT is safe and effective. A significant minority of rt-PA LVO patients experienced recanalization suggesting repeat imaging for transferred patients is appropriate before MT. AF is common and may predict need for MT. Improved TICI score trended with shorter recanalization time and shorter symptom onset to initial CTA time. These data support the use of stroke systems of care for rapid triage and treatment of LVO patients.