Abstract Details

Title Interfacility Transfer for Mechanical Thrombectomy – Direct to Neuroangiography or CT Angiography First?

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-016

Objective

To determine how often CT angiography (CTA) and repeat head CT changed the decision to proceed to mechanical thrombectomy (MT) in patients transferred from other hospitals for consideration of MT.

Background

In patients transferred from other hospitals where a CT has already ruled out hemorrhage, transfer direct to angiography (DTA) suite may reduce door-to-groin time compared to transfer to CTA first. However, this may result in unnecessary catheter angiography if many patients would have been excluded based on CTA results.

Design/Methods An internal transfer database at a comprehensive stroke center (CSC) was used to identify patients transferred from outside facilities for consideration of MT from 7/2016-5/2017. Detailed clinical and radiographic data was extracted using a standard case report form.

Results Of 187 patients transferred for MT, 171 underwent CT+/-CTA on arrival, 5 went DTA, and 11 were admitted without imaging/intervention. Among those undergoing CT+/-CTA on arrival, MT was aborted in 110(64%) patients. Of these, 77(70%) were aborted directly based on imaging findings, with absence of proximal large vessel occlusion (LVO) amenable to MT the most common reason, and 13 (12%) due to rapid clinical improvement or mild deficit. MT was aborted based on imaging findings in 36% of patients with NIHSS≥10 on CSC arrival, and in 29% of patients with NIHSS≥15. In patients with outside CTA demonstrating LVO (n=48), MT was aborted in 48% on CSC arrival, mostly based on dramatic clinical improvement (31%) or imaging findings (48%). CSC arrival-to-groin puncture tended to be shorter in patients going DTA compared to CTA (median 39v54 min, p=0.06).

Conclusions While transfer DTA may be associated with faster door-to-groin puncture times, this might result in many patients undergoing unnecessary catheter angiography who would have been excluded based on CT+/-CTA findings. Even in transferred patients with severe deficits on arrival, imaging excludes about 1/3 of patients from MT.

Authors/Disclosures
Kelley Humbert, MD (Penn Medicine) PRESENTER	Dr. Humbert has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Brett L. Cucchiara, MD (Hosp Uni of Pennsylvania)	Dr. Cucchiara has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Elseiver. Dr. Cucchiara has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Bayer. Dr. Cucchiara has received publishing royalties from a publication relating to health care.

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