Abstract Details

Title CT Perfusion Imaging in Telestroke Facilitates Treatment Decisions Without Delaying Door to Needle Time

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S26 - Cerebrovascular Disease: Systems of Stroke Care (1:00 PM-1:12 PM)

Poster/Presentation
Number 001

Objective We aimed to evaluate the proportion of transfers for endovascular therapy (EVT), door-in-door-out time (DIO) and door-to-needle time (DTN) at telestroke sites before and after CT perfusion (CTP) implementation.

Background Perfusion based imaging aids in patient selection for EVT. Appropriate selection of patients for EVT is an important component in telestroke programs. Despite the advantages of perfusion imaging, there is the concern that advanced imaging may delay DTN time. We implemented CTP using RAPID software at three large primary stroke centers within our telestroke network in December 2017.

Design/Methods Data was prospectively collected and retrospectively analyzed as part of our telestroke quality database. We compared data for one year before and after implementing CTP at the telestroke sites. We hypothesized that: the addition of CTP would not delay DTN; a greater proportion of transfers for possible EVT would receive a stroke thrombectomy; and that DIO would be reduced after utilizing CTP.

Results During the study 1253 patients were evaluated via telestroke and 101 (8.1%) were transferred for a possible EVT. Before CTP, 540 telestroke patients completed CT head and/or CTA head and neck imaging. After CTP, 713 telestroke patients received CT head, CTA and CTP imaging. Patients receiving CTP had a significantly shorter DIO time (median 109 minutes) compared to patients without CTP (median 122 minutes), p=0.04, r =0.26. There was no difference in DTN in patients without CTP (66 minutes) compared to patients who received CTP (63 minutes), p=0.42, r=0.07. There was no significant difference in the proportion of patients transferred for a possible EVT that received a stroke thrombectomy in patients without CTP 28 (74%) compared to patients with CTP 38 (84%), p=0.23.

Conclusions In conclusion, automated perfusion maps and calculated ischemic penumbra size in CTP allowed telestroke physicians to make quicker transfer decisions, without delaying DTN.

Authors/Disclosures
Chris Hackett, MA PRESENTER	Mr. Hackett has nothing to disclose.
Russell M. Cerejo, MD (Allegheny health Network)	Dr. Cerejo has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Ischemaview.
Robert Fishman, MD (Butler Hospital)	Dr. Fishman has nothing to disclose.
David G. Wright, MD	Dr. Wright has nothing to disclose.
Sandeep S. Rana, MD, FAAN (Allegheny Health Network)	Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CSI. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pharmawrite. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biohaven. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Argenx. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving as a Consultant for amylyx. Dr. Rana has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion.
Ashis H. Tayal, MD	Dr. Tayal has nothing to disclose.

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