Abstract P163: LVO Screening and Transfer During Covid-19 Surge in Louisiana

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Paige Hargrove ◽  
Deborah Spann ◽  
Yvette Legendre ◽  
Ted Colligan ◽  
Sheryl Martin-Schild
Keyword(s):  
Acute Stroke ◽  
New Orleans ◽  
Median Time ◽  
Ambulance Service ◽  
Large Vessel ◽  
Stroke Therapy ◽  
Stroke Registry ◽  
Secondary Transfer ◽  
Time Periods ◽  
Acute Stroke Therapy

Background: The first surge of COVID-19 cases in Louisiana began in late March 2020 in the Greater New Orleans Area and quickly spread throughout the state. We sought to determine if LVO screening and door in-door out (DIDO) among patients who screened positive for large vessel occlusions (LVO) deteriorated. Methods: Our statewide stroke registry, mandatory for hospitals attesting to Acute Stroke Ready Hospital status, was queried. We compared LVO screening and transfer efficiency during Q1 and Q2 2020 with Q3 and Q4 2019. Results: Patients presenting within 24hr of last seen normal declined by 11%. The proportion arriving by ambulance increased (50.6% vs 40.7%, p<0.0001). Screening for LVO increased (84.4% vs 77.0%%, p<0.0001). Use of Vision-Aphasia-Neglect assessment increased (74.6% vs 66.2%%, p<0.0001). The proportion screening positive for LVO insignificantly decreased (23.1% vs 26.0%, p=0.1233). The median time from door in to transfer request was stable (63min during both time periods). The median time from transfer request to departure increased (58min vs 48min). The DIDO increased by 24 minutes (135min vs 111min). Delay due to achieving acceptance in hub center and secondary transfer ambulance were the most common reasons documented for prolonged DIDO. Discussion: Louisiana experienced a reduction in acute stroke presentation during COVID-19. Screening for LVO actually improved during this time, but DIDO was compromised due to problems securing transfer acceptance and secondary ambulance service. Earlier identification and initiation of secondary transfer for patients screening positive for LVO should help improve efficiency in delivering acute stroke therapy.

Abstract P182: Stroke Therapy in the Time of Covid-19

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Paige Hargrove ◽  
Deborah Spann ◽  
Yvette Legendre ◽  
Ted Colligan ◽  
Sheryl Martin-Schild
Keyword(s):  
Stroke Volume ◽  
Acute Stroke ◽  
New Orleans ◽  
Thrombolytic Treatment ◽  
Stroke Therapy ◽  
Treatment Efficiency ◽  
Treatment Rate ◽  
Careful Evaluation ◽  
Stroke Registry ◽  
Acute Stroke Therapy

Background: The first surge of COVID-19 cases in Louisiana began in late March 2020 and was centered on the Greater New Orleans Area. Louisiana is divided into 9 regions; New Orleans is in Region 1. A statewide survey indicated 100% of hospitals experienced a decline in stroke presentations. We sought to determine if treatment of stroke with intravenous (IV) thrombolytic declined or was delayed relative to pre-COVID-19. We also sought to evaluate a change in door in-door out (DIDO) for secondary transfers among patients who screened positive for large vessel occlusions (LVO). Methods: Our statewide stroke registry, mandatory for hospitals attesting to Acute Stroke Ready Hospital status, was queried. We compared stroke volume, treatment rate with IV thrombolytic, treatment efficiency, and DIDO in 2019 with March 2020 and Q2 2020. Results: Monthly stroke presentations declined by 20% starting March 2020 compared to the average monthly volume in 2019. The IV thrombolytic rate was down from 10.3% to 8.8% in Q2 2020. In Q2 2020, the median door-to-needle time was 12 minutes longer than it was during 2019 and the proportion with a documented reason for delay increased from 29.1 in 2019 to 33.3% in March 2020 and 37.5% in Q2 2020. The median DIDO increased by 13 minutes compared to 2019 (129 vs 116 minutes). Discussion: Louisiana experienced a reduction in stroke presentation following the initial surge of COVID-19 cases. The treatment rate and efficiency with IV thrombolytic declined and DIDO was prolonged among patients with suspected LVO. Careful evaluation of how the stroke code processes changed in response to COVID-19 may help to recover efficiency in delivering acute stroke therapy.

Abstract TP323: The Role of Ejection Fraction in 90 Day Functional Outcome in Acute Ischemic Infarction Patients Receiving Acute Stroke Therapy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tamra Ranasinghe ◽  
Brett Meyer ◽  
Richard Lane ◽  
Dawn Meyer
Keyword(s):  
Acute Stroke ◽  
Functional Outcome ◽  
Pearson Correlation ◽  
Recombinant Tissue Plasminogen Activator ◽  
Continuous Variables ◽  
Stroke Therapy ◽  
Stroke Registry ◽  
The Relationship ◽  
Acute Stroke Therapy ◽  
Iv Tpa

Background: Cardiovascular disease is associated with unfavorable outcomes following acute ischemic stroke (AIS). Left ventricularejection fraction (LVEF) alone has not been reported as a significant predictor of unfavorable outcomes in observational studies of AIS.The purpose of this study was to evaluate the relationship between LVEF and 90 day functional outcome in AIS patients who received acute stroke therapy with IV recombinant tissue plasminogen activator (rt-PA), endovascular therapy (EVT), or combination IV rt-PA+EVT. Methods: This was a retrospective review of prospectively collected data from the University of California San Diego (UCSD) Stroke registry from October 2014-June 2019. Analysis included all patients for whom a stroke code was activated and who had a transthoracic echocardiogram (TTE) during stroke admission or within the previous 30 days prior to AIS. Acute stroke therapy was defined as 1) IV tPA only; 2) EVT only; or 3) IV tPA + EVT. LVEF function was defined as: low <35%, moderately low 36 -49% and normal >50% on TTE. Primary outcome was modified ranking scale(mRS) at 90 days post stroke. Data was examined for frequencies and distribution. Continuous variables were assessed by Pearson correlation and t test. Kruskal-Wallis or ANOVA were used to evaluate group differences. ANCOVA was used for adjusted analysis. Results: In the 227 patients identified, low EF patients were more likely to have atrial fibrillation (61.9%, p=.004) and lower mean admission systolic blood pressure (132.6, p=0.009). LVEF was not significantly associated with 90 day outcome in all treated patients in both unadjusted (p=0.992) and adjusted (p=0.62). LVEF was not significantly associated with 90 day outcome for individual acute stroke therapy groups both unadjusted and adjusted. mRS at 90 days was significantly associated with baseline NIHSS (p<0.001), age (p=0.002), and treatment with IV tPA (p=0.01). Conclusion: In this study, LVEF was not independently associated with 90 day functional outcome in AIS patients who received acute stroke therapy. Further studies in more heterogenous samples are warranted to assess the relationship between LVEF and outcome in all stroke populations.

Abstract 96: CTP-Mismatch Maps Improve Interobserver Agreement

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Waimei A Tai ◽  
Archana Purushotham ◽  
Matus Straka ◽  
Rebecca M Sugg ◽  
Naveed Akhtar ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Ct Perfusion ◽  
Interobserver Reliability ◽  
Observer Agreement ◽  
Absolute Difference ◽  
Stroke Therapy ◽  
Adequate Quality ◽  
Ischemic Core ◽  
Observer Disagreement ◽  
Acute Stroke Therapy

Introduction: The use of mismatch between the ischemic core and penumbra to select patients who are likely to benefit from acute stroke therapy has gained popularity. Interpretation of the ischemic core and penumbra on standard CT-perfusion (CTP) maps is subjective. This may lead to variability among physicians in the decision if a patient is a good candidate for acute stroke therapy. A CTP-Mismatch map with outlines of the ischemic core and penumbra could limit this variability. The goal of this study was to determine if inter-observer agreement regarding a patient’s suitability for acute stroke therapy improves with the use of a CTP-Mismatch map. The figure shows a typical CTP-Mismatch map. Methods: Ninety-six consecutive patients evaluated with CTP prior to intra-arterial therapy at St. Lukes Hospital in 2008-09 were included. 79 patients had adequate quality CTP for this analysis. Standard CTP maps (CBV, CBF, MTT, and Tmax) and a CTP-Mismatch map were generated with a fully automated program for processing of CTP source images (RAPID). RAPID assessed the ischemic core using a CBF threshold <30% of the contralateral hemisphere (rCBF<30%). The ischemic penumbra was defined by a Tmax threshold of >6 sec (Tmax>6s). The standard CTP maps and the CTP-Mismatch map were independently analyzed by two vascular neurologists in a blinded fashion. The raters assessed a patient's suitability for intra-arterial therapy based on the following mismatch criteria: (1) a ratio between (Tmax>6s) and (rCBF<30%) volumes >1.8 and (2) an absolute difference between (Tmax>6s) and (CBF<30%) volumes >15ml. Interobserver reliability was assessed with Cohen’s kappa. Results: When assessment of suitability for intra-arterial therapy was based on interpretation of standard CTP maps, the two raters agreed in 58 of 79 patients (kappa=0.46; 95% CI=0.24-0.60). The agreement between observers improved when suitability was determined using CTP-Mismatch maps (agreement in 76 of 79 cases; kappa=0.92; 95% CI=0.75-0.92; p<0.001 for difference between kappa values). The 3 cases with inter-observer disagreement had artifact on the CTP-Mismatch map. Following concensus adjudication of these 3 cases, 40 of the 79 patients (51%) were deemed suitable candidates for acute stroke therapy. Conclusion: CTP-Mismatch maps with estimates of ischemic core and penumbra volumes markedly improve inter-observer agreement regarding assessment of suitability for acute stroke therapy. Such maps, which can be generated automatically, may help standardize decision making algorithms for evaluation of potential intra-arterial therapy candidates.

Abstract WP121: Incorporating CT-Perfusion Imaging in Acute Stroke Therapy Workflow Does Not Delay Door to Needle Time for Intravenous t-PA

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Bahareh Sianati ◽  
Russel Cerejo ◽  
David Wright ◽  
Ashish Tayal ◽  
Patty Noah ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Perfusion Imaging ◽  
Ct Perfusion ◽  
Brain Perfusion ◽  
Stroke Therapy ◽  
Brain Perfusion Imaging ◽  
Group 2 ◽  
Acute Stroke Therapy ◽  
Iv Tpa ◽  
Group 1

Introduction: Brain perfusion imaging has become an integral part of acute stroke therapy, especially for the extended time window. A streamlined workflow is essential to reduce delays in acute stroke therapy. Incorporating standard and advanced imaging together may reduce time to endovascular therapy but may delay administration of intravenous (IV) tPA. Method: A retrospective analysis of all acute stroke therapy cases between August 2017 and March of 2018 was performed at a single stroke center. Brain perfusion imaging was instituted into the workflow in December of 2017. We included patients who received IV tPA before and after implementation of CT perfusion (CT-P). Demographics, clinical presentation, stroke treatment times and imaging characteristics were collected. Results: During the eight-month period, we identified 117 patients who met inclusion criteria. We divided the cohort into two groups, pre CT-P implementation (Group 1) and post CT-P implementation (Group 2). We identified 66 patients in Group 1 and 51 patients in Group 2. In Group 1, 29 (44%) were females with median age of 63 years. In Group 2, 33 (65%) were females, with median age of 72 years. There was no difference in median times for door to needle in Group 1 (57 minutes, interquartile range [IQR] 42 – 76) compared to Group 2 (53 minutes, [IQR] 40 – 68) ( P = 0.20). Conclusion: Incorporating CT-P in the imaging workflow did not delay door to needle time for IV tPA in acute stroke therapy.

Turning Point of Acute Stroke Therapy: Mechanical Thrombectomy as a Standard of Care

2015 ◽  
Vol 83 (6) ◽  
pp. 953-956 ◽  
Author(s):  
Keith G. DeSousa ◽  
Matthew B. Potts ◽  
Eytan Raz ◽  
Erez Nossek ◽  
Howard A. Riina
Keyword(s):  
Acute Stroke ◽  
Turning Point ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Stroke Therapy ◽  
Acute Stroke Therapy
Sign in / Sign up

Export Citation Format

Share Document