Abstract WP247: Facilitating Pre-hospital Communication between Neurology and Witness Reduces IV Alteplase Initiation Times

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Cortlyn J Elshire ◽  
Lindsay Olson-Mack ◽  
Jean Rockwell ◽  
Sara Deskin ◽  
Lynn Berger ◽  
...  
Keyword(s):  
Medical History ◽  
Intervention Group ◽  
Treatment Decision ◽  
Standard Of Care ◽  
Care Group ◽  
Exclusion Criteria ◽  
Hospital Arrival ◽  
Fire Stations ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: American Stroke Association guidelines recommend pre-hospital stroke code notification via EMS to facilitate prompt treatment decision for acute ischemic stroke (AIS) patients. Despite pre-notification to the stroke team, treatment decisions are often delayed until medical history and last known well times are established. Hypothesis: We hypothesized that screening for IV Alteplase candidacy and obtaining pertinent medical history from a witness or patient during a pre-hospital stroke code activation prior to hospital arrival would decrease door to needle (DTN) times. Methods: A retrospective analysis was conducted on 193 patients presenting to the emergency department (ED) at a Comprehensive Stroke Center (CSC) from February 2016 through July 2016. A process improvement (PI) event was initiated between the CSC and two fire stations with a catchment time of > 10 minutes. For pre-hospital activated stroke codes, the witness or patient was provided the contact card and encouraged to call the centralized number to the Neurologist. Inclusion criteria: All patients presenting to the ED with EMS pre-hospital stroke code activation. Exclusion criteria: Patients presenting to the ED with stroke code initiated after arrival, or medic response events which did not lead to a pre-hospital stroke code activation. Results: After applying criteria, 126 met inclusion and exclusion criteria. A total of 19 patients arrived via the 2 fire stations with pre-hospital stroke code initiations and serve as our intervention group, while 107 patients underwent standard of care. Contact cards were provided to 11 patients (58%) in the intervention group prior to arrival. IV Alteplase was initiated for 3 of 11 patients (27.3%) in the intervention group vs. 19 of 107 patients (17.8%) in the standard of care group. Mean and median DTN times in the intervention group was 36 minutes as compared to a mean of 46.1 minutes and median time of 40 minutes receiving standard of care. Conclusions: Preliminary data suggest that DTN times can be decreased when medical history is obtained prior to hospital arrival to screen for IV Alteplase eligibility. This study warrants further investigation in pre-acquisition of history for pre-hospital stroke code patients.

Abstract MP20: The Effect of the Covid-19 Pandemic on Stroke Code Time Metrics at an Academic, Comprehensive Stroke Center

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dawn M Meyer ◽  
Benjamin Shifflett ◽  
Reza Bavarsad Shahripour ◽  
Tamra Ranasinghe ◽  
Dolores Torres ◽  
...  
Keyword(s):  
Arrival Time ◽  
Treatment Decision ◽  
Stroke Care ◽  
Demographic Variables ◽  
Hospital Arrival ◽  
Stroke Registry ◽  
Treatment Administration ◽  
Race Ethnicity ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: The COVID-19 pandemic forced immediate changes to stroke code protocols to maintain safety of patients and providers. We hypothesize that stroke code time metrics were significantly longer in the peri-COVID stroke code activations compared to pre-COVID activations. Methods: We analyzed data from an IRB-approved, prospectively collected stroke registry at a large academic, comprehensive stroke center (CSC). We included all patients that presented as stroke code activations from June 2009-August 2020, excluding spoke telestroke and in-house codes. Pre-COVID was defined as June 1, 2009-March 11, 2020 and peri-COVID March 12, 2020 to August 11, 2020. The pre-pandemic stroke code protocol began June 2009. We assessed The Joint Commission stroke code time metrics between groups. Demographic variables of baseline NIHSS, sex, race/ethnicity, age, smoking, pertinent past medical history, arrival mode, and baseline glucose were assessed. A t-test was used to compare stroke code time metrics in minutes. All analyses were done unadjusted. Results: We assessed 813 pre and 328 peri-COVID stroke code activations. Baseline demographics were significant only for an increased number of Hispanics in the pre-COVID group (22.9% vs 11.1%, p<0.001). Onset to hospital arrival time was significantly longer in the peri-COVID compared to pre-COVID group (244 vs 110 min, p<0.001). Onset to stroke code activation was significantly longer in the peri-COVID compared to pre-COVID group (243.8 vs 116.8 min, p<0.009). Time from arrival to treatment decision was significantly decreased in the peri-COVID group (29.9 vs 39.6 min, p=0.04). Time from arrival to CT scan completed (p=0.37), arrival to treatment administration (p=0.06), and onset to treatment administration (p=0.48) were not significantly different between groups. Conclusion: The COVID-19 pandemic significantly impacted the volume and demographic of stroke patients seeking emergency care. This data supports the trend of patients delaying emergent stroke care. This academic, CSC developed and implemented a COVID-19 stroke code protocol within days of a statewide lockdown. The use of telestroke in this peri-pandemic protocol may have accounted for the significant decrease in time to treatment decision.

Abstract WP429: A Nurse Driven Acute Stroke Alert Process Improves Treatment Times and Treatment Rates

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel D'Amour ◽  
Jayme Strauss ◽  
Amy K Starosciak
Keyword(s):  
Treatment Time ◽  
Treatment Decision ◽  
Treatment Rate ◽  
Treatment Decision Making ◽  
National Rate ◽  
Number Of Patients ◽  
Stroke Team ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Positive Effect

Introduction: Treatment time has gained sufficient popularity because it is now well-known that “Time is Brain”. Treatment rates, however, lag behind in importance even though more lives can be saved by treating more often. Our TJC Comprehensive Stroke Center has a nurse-led stroke alert process that focuses on multiple, rapid, parallel steps to reduce DTN for IV alteplase. The Baptist Emergency Stroke Team (BEST) responders are highly-trained and skilled nurses that assess, coordinate, and initiate processes to ensure the best times. We identified that our treatment rate was lower than the national rate for certified CSCs, so the BEST responders used a stepwise process to develop their own interventions to improve rates. Methods: First, the BEST responders started tracking our monthly rate. Next, they set a rate goal, and then brainstormed how to influence treatment decision-making. The BEST team initiated a monthly PI meeting that focused on the importance of treating disability rather than an NIHSS score. Then the team scripted and rehearsed critical conversations to have providers that advocated specifically for treating disability. The team adopted the motto, “Treat Disability, Not Numbers”. Results Conclusions: Our CSC observed a small decrease in median DTN but double the treatment rate after the BEST responder intervention. In comparison, these statistics did not change at the national CSC level. The sICH rate was reduced from Period A to C, meaning that increased treatment rate did not lead to increased hemorrhagic rate. Nursing initiatives can have a substantial positive effect on increasing the number of patients treated with IV alteplase for acute ischemic stroke.

Abstract TP303: Real-world Eligibility for Revascularization in Acute Stroke: A 12 Year Single Center Statistics

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Peter Vanacker ◽  
Dimitris Lambrou ◽  
Ashraf Eskandari ◽  
Patrik Michel
Keyword(s):  
Time Windows ◽  
Standard Of Care ◽  
Stroke Care ◽  
Regional Level ◽  
Effective Number ◽  
Single Center ◽  
Resource Needs ◽  
Liberal Approach ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Aims: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is the new standard of care for well selected, large vessel occlusive strokes. Hypothesis: We aimed to determine the frequency of patients potentially eligible for IV thrombolysis (IVT) and EVT based on the latest AHA/ASA guidelines. Methods: Data from a prespecified consecutive AIS registry (ASTRAL, 2003-2014) of a single comprehensive stroke center were examined. All AIS admitted <24hours and sufficient data to determine EVT-eligibility according to AHA/ASA guidelines (class I and IIa recommendations) on IVT and EVT were selected. Another set of more liberal criteria from different EVT trials and clinical practice was also tested. Time windows for EVT-eligibility was 4.5h (allowing for a door-to-groin delay ≤90min) and for IVT 3.5h (door-to-needle delay ≤60min). Results: A total of 2’704 AIS were included, of whom 26.8% were secondary transferrals. Proportion of IVT-eligible patients was 12.4% for all AIS, and 24.6% and 36.2% for patient arriving <24h and 6h respectively. Frequency of EVT-eligibility differed between the AHA/ASA guideline and the more liberal approach: 2.9% vs. 4.9% of all AIS and 10.5% vs. 17.7% of all patients arriving <6hours. These numbers are in line with the effective number of EVT applied in 2013 (15%) and 2014 (12%). Conclusions: Of patients arriving within 6h at a comprehensive stroke center, 10.5% are EVT eligible according to AHA/ASA criteria, nearly double (17.7%) with more liberal criteria, and again double for IV thrombolysis (36.2%). These figures may be useful for planning resource needs of stroke care on a regional level.

Abstract 1122‐000091: Predictors of Symptomatic Hemorrhagic Transformation After Mechanical Thrombectomy in Acute Ischemic Stroke

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Anqi Luo ◽  
Agnelio Cardenas ◽  
Lee A Birnbaum
Keyword(s):  
Risk Factors ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Hemorrhagic Transformation ◽  
Current Standard ◽  
Vessel Occlusion ◽  
Increased Risk ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Iv Tpa

Introduction : Mechanical thrombectomy (MT) has become the current standard of care for large vessel occlusion stroke but is associated with an increased risk of intracranial hemorrhage (ICH). Although several studies have investigated the risk factors, there is still limited, not well‐established data. This study aims to evaluate the risk factors of HT after MT. Methods : We retrospectively reviewed all MT patients who were treated at a single comprehensive stroke center from 12/2016 to 7/2019. Variables included initial NIHSS, blood glucose, initial systolic blood pressure, age, gender, IV tPA, time from door to recanalization, and TICI score. Outcome measures were HT on post‐procedure or 24‐hour post‐tPA head CT/MRI as well as modified Rankin scale (mRS) upon discharge. Results : Among 74 patients (68.8 ± 14 years, men 47.3%), 9 (12.2%) experienced hemorrhagic transformation after thrombectomy. Average admitting NIHSS was significantly higher in the HT group (22 vs 16.8, p = 0.041). TICI 3 after MT was protective for HT (OR 0.078, 95% CI 0.009‐0.663). IV tPA (OR 3.86, 95% CI 1.448‐10.326) was associated with good neurological outcome at discharge (mRS < = 2), but HT was not (OR 0.114, 95% CI 0.013‐0.964). Patients with mRS < = 2 upon discharge were younger (65.2±12 vs 71.9±15, p = 0.04) and had lower initial BG (124±45.8 vs 157±69.6, P = 0.02). Conclusions : TICI 3 score, decreased NIHSS, and lower BG were associated with less HT and better outcomes in our MT cohort. Admitting NIHSS > = 20 may be a reasonable threshold to predict HT after MT. Our findings are consistent with the TICI‐ASPECTS‐glucose (TAG) score to predict sICH; however, we used initial NIHSS as a surrogate for ASPECTS. Further studies may utilize additional quantitative measures such as CTP data to predict HT.

Abstract P2: Results of a Prospective Observational Cohort Study of Tenecteplase as Standard of Care Stroke Thrombolytic

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Steven J Warach ◽  
Jefferson T Miley ◽  
Manzure Mawla ◽  
Samantha Miller ◽  
Ming-Chieh Ding ◽  
...  
Keyword(s):  
Missing Values ◽  
Cohort Analysis ◽  
Standard Of Care ◽  
Historical Cohort ◽  
Hospital Arrival ◽  
Observational Cohort ◽  
Recorded Data ◽  
Independent Ambulation ◽  
Stroke Center ◽  
Get With The Guidelines

Background: Our 10-hospital network (2 CSCs, 2PSCs, 6 non-SCs) switched our standard stroke thrombolytic from alteplase (ALT) to tenecteplase (TNK; 0.25 mg/kg) in September 2019. Methods: We designed a two-year prospective cohort analysis of key processes and clinical outcomes for TNK-treated patients with planned quarterly assessments of feasibility and safety. The TNK cohort is compared to the retrospective historical cohort of all unique patients at these hospitals treated with ALT during the prior 2-year period (n=354). Analysis were taken from a local REDcap registry that recorded data fields required for Stroke Center certification and submission to Get-With-The Guidelines (GWTG). Interim results through three quarters ending June 30, 2020. Results: 151 patients were treated with TNK. The samples TNK v ALT were well matched on age (median, IQR) 66.0 (55.0, 76.0) v 67.0 (55.0, 78.8) and NIHSS at admission (median, IQR), 8 (4, 13) v 8 (4, 15). Symptomatic ICH (ECASS 3 definition) occurred in 2.0% of TNK and 2.3% of ALT treated patients; all but one symptomatic ICH occurred in patients treated with both thrombolytic and endovascular therapies. All cause in-hospital mortality was 3.3% and 6.8%, respectively. No differences were observed in early outcomes of discharge to home (52%, 53%) or independent ambulation (46%, 45%). Day 90 Rankin Score (last observation carried forward for missing values) was available only for TNK: mRS 0-1 in 46.4% (95%CI 38.6%-54.3%), 0-2 in 55.6% (95%CI 47.7%-63.3%). A significantly greater proportion of patients were treated with the lytic within 45 minutes of hospital arrival after the switch to TNK using Get-With-The-Guidelines DTN time criteria (Table), most notably at the primary stroke centers. Conclusions: To date, the transition to TNK was associated with reductions in DTN times and in Drip-and-Ship transfer times (see related abstract). No differences were seen on early indices of safety or efficacy.

Use of computed tomography perfusion for acute stroke in routine clinical practice: Complex scenarios, mimics, and artifacts

2018 ◽  
Vol 13 (5) ◽  
pp. 469-472 ◽  
Author(s):  
Carlos Garcia-Esperon ◽  
Andrew Bivard ◽  
Christopher Levi ◽  
Mark Parsons
Keyword(s):  
Computed Tomography ◽  
Acute Stroke ◽  
Treatment Decision ◽  
Added Value ◽  
Stroke Treatment ◽  
Computed Tomography Perfusion ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Weighted Sequences ◽  
Perfusion Maps

Background Computed tomography perfusion is becoming widely accepted and used in acute stroke treatment. Computed tomography perfusion provides pathophysiological information needed in the acute decision making. Moreover, computed tomography perfusion shows excellent correlation with diffusion-weighted imaging and perfusion-weighted sequences to evaluate core and penumbra volumes. Multimodal computed tomography perfusion has practical advantages over magnetic resonance imaging, including availability, accessibility, and speed. Nevertheless, it bears some limitations, as the limited accuracy for small ischemic lesions or brainstem ischemia. Interpretation of the computed tomography perfusion maps can sometimes be difficult. The stroke neurologist faces complex or atypical cases of cerebral ischemia and stroke mimics, and needs to decide whether the “lesions” on computed tomography perfusion are real or artifact. Aims The purpose of this review is, based on clinical cases from a comprehensive stroke center, to describe the added value that computed tomography perfusion can provide to the stroke physician in the acute phase before a treatment decision is made.

Abstract WP56: The Hypoperfusion Intensity Ratio is a Poor Discriminator of Infarct Growth in Fully Reperfused Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Krishnan Ravindran ◽  
Mehdi Bouslama ◽  
Gabriel Rodrigues ◽  
Diogo Haussen ◽  
Leonardo Pisani ◽  
...  
Keyword(s):  
Intensity Ratio ◽  
Infarct Volume ◽  
Treatment Decision ◽  
Lesion Volume ◽  
Treatment Decision Making ◽  
Fast Progression ◽  
The Difference ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background and Purpose: The hypoperfusion intensity ratio (HIR) is a perfusion-weighted imaging parameter defined as the ratio of Tmax>10 seconds : Tmax>6 seconds volume and is believed to be reflective of collateral strength and consequently influence infarct growth. We sought to assess the utility of the HIR in predicting infarct growth in patients undergoing thrombectomy at a comprehensive stroke center (CSC). Methods: Consecutive acute ischemic stroke patients transferred to our CSC from 09/2010-11/2018 were identified and included if the following criteria were met: 1)computed tomography perfusion (CTP) imaging enabling assessment of baseline ischemic core volume and HIR 2) follow-up neuroimaging for assessment of final infarct volumes and 3)modified Thrombolysis In Cerebral Infarction scale (mTICI) 2c status or greater post-thrombectomy. Infarct growth rate (IGR) was calculated as the difference between infarct volume on follow-up imaging and the acute DWI lesion volume, divided by time from CTP to reperfusion in hours. Results: 461 patients (median age, 64 [55-75] years, median baseline NIHSS, 16 [12-21]) were eligible for this analysis. HIR poorly correlated with IGR (Spearman’s rho=0.001, p=0.89). An HIR cut-off of 0.5 was not able to discriminate ‘fast progressors’ (IGR>5 mL/hr) (AUC 0.42, sensitivity 40%, specificity 51%), or IGR at thresholds of either 2.5 or 10 mL/hr (AUC 0.44 and 0.49 respectively, with 95% confidence intervals [0.35-0.52] and [0.41-0.57], respectively). Similarly, an HIR of 0.5 only weakly distinguished ‘fast progression’ in patients reperfused beyond 120 min from imaging and patients with early CTP (last known well to CTP<6 hrs) (AUC 0.59, sensitivity 43%, specificity 68% and AUC 0.50, sensitivity 45%, specificity 55%). On multiple regression analysis, HIR was not predictive of infarct growth (regression equation=18.09+8.48x, F=2.46, p=0.11, R 2 =0.13) but was predictive of ‘fast progression’ (OR 0.22, 95% CI [0.09-0.60], p=0.003, pseudo-R 2 =0.16). Conclusions: Though predictive of fast progression, the HIR is a poor discriminator of infarct growth in successfully reperfused thrombectomy patients who undergo perfusion imaging at a CSC, and thus should not be factored into treatment decision-making.

Aiming Beyond: A Pharmacist Impact on 90-Day Readmissions and Clinical Outcomes Within a Family Medicine Service

2019 ◽  
Vol 33 (6) ◽  
pp. 738-744
Author(s):  
Lindsey E. Wiegmann ◽  
Matthew S. Belisle ◽  
Kristin S. Alvarez ◽  
Neelima J. Kale
Keyword(s):  
Family Medicine ◽  
Intervention Group ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Care Group ◽  
Readmission Rates ◽  
Medicine Service ◽  
The Impact ◽  
Disease Specific

Previous studies have shown pharmacists positively impact 30-day readmission rates. However, there is limited data regarding the effect of clinical pharmacist (CP) follow-up on 90-day readmission or evaluation of disease-specific goals after hospitalization. Investigators analyzed the impact of postdischarge extended CP follow-up within a family medicine service (FMS). The primary end point was all-cause 90-day readmission rates. Secondary end points included all-cause 30- and 60-day readmission rates and the achievement of disease-specific goals postdischarge. Retrospective chart review was performed for patients admitted from August 2016 to November 2017 who were seen by a physician within the FMS 14 days postdischarge. Fourteen percent of patients within the CP intervention group were readmitted within 90 days in comparison to 22% in the standard of care group ( P = .244). Readmission rates at 30 and 60 days were as follows: intervention group 2%, 10%, and standard of care group 16%, 22% ( P = .015, P = .089, respectively). In addition, multiple patients with uncontrolled diabetes who completed CP visits upon hospital discharge met glycemic goals at the end of the study time period. Despite inclusion of the CP in postdischarge care, 90-day readmission rate remained unchanged.

scholarly journals A short history of thrombectomy – Procedure and success analysis of different endovascular stroke treatment techniques

2020 ◽  
pp. 159101992096188
Author(s):  
B Friedrich ◽  
T Boeckh-Behrens ◽  
V Krüssmann ◽  
S Mönch ◽  
J Kirschke ◽  
...  
Keyword(s):  
Final Analysis ◽  
Standard Of Care ◽  
Clinical Results ◽  
Technical Approach ◽  
Level Of Evidence ◽  
Stroke Treatment ◽  
Treatment Techniques ◽  
Materials Used ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background The historical development of interventional stroke treatment shows a wide variation of different techniques and materials used. Thus, the question of the present work is whether the technical and procedural differences of thrombectomy techniques lead to different technical and clinical results. Methods and results Analysis of a mixed retrospective/prospective database of all endovascular treated patients with an occlusion of the Carotid-T or M1 segment of the MCA at a single comprehensive stroke center since 2008. Patients were classified regarding the technical approach used. Six hundred sixty-eight patients were available for the final analysis. Reperfusion rates ranged between 56% and 100% depending on the technical approach. The use of balloon guide catheters and most recently the establishment of combination techniques using balloon guide catheters, aspiration catheters and stent retrievers have shown a further significant increase in the rates of successful recanalization, full recanalization and first-pass recanalization. Additionally, the technical development of interventional techniques has led to a subsequent drop in complications, embolization into previously unaffected territories in particular. Conclusion Technical success of MT has improved substantially over the past decade owing to improved materials and procedural innovations. Combination techniques including flow modulation have emerged to be the most effective approach and should be considered as a standard of care. Level of evidence: Level 3, retrospective study.

Abstract P492: The Hypoperfusion Intensity Ratio is a Poor Discriminator of Infarct Growth in Fully Reperfused Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Krishnan Ravindran ◽  
Gabriel M Rodrigues ◽  
Diogo C Haussen ◽  
Mehdi Bouslama ◽  
Michael Frankel ◽  
...  
Keyword(s):  
Intensity Ratio ◽  
Infarct Volume ◽  
Treatment Decision ◽  
Lesion Volume ◽  
Treatment Decision Making ◽  
Fast Progression ◽  
The Difference ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background and Purpose: The hypoperfusion intensity ratio (HIR) is a perfusion-weighted imaging parameter defined as the ratio of Tmax>10 seconds : Tmax>6 seconds volume and is believed to be reflective of collateral strength and consequently influence infarct growth. We sought to assess the utility of the HIR in predicting infarct growth in patients undergoing thrombectomy at a comprehensive stroke center (CSC). Methods: Consecutive acute ischemic stroke patients transferred to our CSC from 09/2010-11/2018 were identified and included if the following criteria were met: 1)computed tomography perfusion (CTP) imaging enabling assessment of baseline ischemic core volume and HIR 2) follow-up neuroimaging for assessment of final infarct volumes and 3)modified Thrombolysis In Cerebral Infarction scale (mTICI) 2c status or greater post-thrombectomy. Infarct growth rate (IGR) was calculated as the difference between infarct volume on follow-up imaging and the acute DWI lesion volume, divided by time from CTP to reperfusion in hours. Results: 461 patients (median age, 64 [55-75] years, median baseline NIHSS, 16 [12-21]) were eligible for this analysis. HIR poorly correlated with IGR (Spearman’s rho=0.001, p=0.89). An HIR cut-off of 0.5 was not able to discriminate ‘fast progressors’ (IGR>5 mL/hr) (AUC 0.42, sensitivity 40%, specificity 51%), or IGR at thresholds of either 2.5 or 10 mL/hr (AUC 0.44 and 0.49 respectively, with 95% confidence intervals [0.35-0.52] and [0.41-0.57], respectively). Similarly, an HIR of 0.5 only weakly distinguished ‘fast progression’ in patients reperfused beyond 120 min from imaging and patients with early CTP (last known well to CTP<6 hrs) (AUC 0.59, sensitivity 43%, specificity 68% and AUC 0.50, sensitivity 45%, specificity 55%). On multiple regression analysis, HIR was not predictive of infarct growth (regression equation=18.09+8.48x, F=2.46, p=0.11, R 2 =0.13) but was predictive of ‘fast progression’ (OR 0.22, 95% CI [0.09-0.60], p=0.003, pseudo-R 2 =0.16). Conclusions: Though predictive of fast progression, the HIR is a poor discriminator of infarct growth in successfully reperfused thrombectomy patients who undergo perfusion imaging at a CSC, and thus should not be factored into treatment decision-making.

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