Abstract P286: The Effects of COVID-19 on the Reasons for Not Calling 911 for Acute Stroke

Objective: Our Stroke Program regularly provides community outreach and stroke education. The stroke team educates on signs and symptoms of stroke, risks factors, and 911 activation. Within a few days of discharge, Neuroscience nurses call stroke patients to ensure patients have obtained their prescription medications, have follow-up appointments, inquire about their satisfaction with our services, and reinforce stroke education. As part of these calls, our team asked why patients/families did not call 911. The purpose of this study was to determine if the COVID-19 crisis influenced the reasons why 911 was not called for possible stroke to better plan for targeted stroke education. Method: Discharge phone survey data from our stroke network was collected from Feb-Jul 2019 and compared to Feb-Jul 2020. Our stroke network includes 1 comprehensive stroke center and 2 primary stroke centers. Emergency Department (ED) stroke activation data was gathered for the same time periods. Discharge phone calls data was based on discharge date, whereas ED stroke alert data was based on admission date. Results: There was a notable decline in stroke volume between 2019 to 2020 with the largest decline occurring during the first peak (Apr 2020) in COVID-19 cases within our state. This decline was driven by a 16% decline in walk-in ED stroke arrivals as compared to a 1% decline in EMS stroke arrivals. Of those who did not call 911 in 2020, there was a 7% increase in failing to recognize stroke symptoms as an emergency, a 6% increase in concern about EMS cost, and 6% decrease in hospital preference. Conclusion: The COVID-19 crisis negatively influenced stroke volumes within our system stroke program. Reductions in stroke walk-ins accounted for this decline. COVID-19 affected the reasons why 911 was not called. The largest increase was in not recognizing stroke symptoms as an emergency and increased concern about EMS associated costs. Surprisingly, COVID-19 was not listed as a reasons for avoiding 911. Targeted community educational efforts on these concerns may lead to improved 911 usage for suspected stroke during the COVID-19 pandemic. Limitations: Further research is needed to investigate why those with a stroke who would have been walk-ins decided not to seek urgent medical attention.

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Abstract WP373: Emergency Medical Service Stroke Education in a Rural Community: Need for Improvement

Stroke ◽

10.1161/str.48.suppl_1.wp373 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Pauline M Rankin ◽

Dianne Marsh ◽

James McLaughlin

Keyword(s):

Emergency Medical Services ◽

Emergency Medical Service ◽

Medical Service ◽

Signs And Symptoms ◽

Stroke Patients ◽

Emergency Medical ◽

Primary Stroke Center ◽

Stroke Education ◽

Comprehensive Stroke Center ◽

Stroke Center

According to The Journal of Emergency Medical Services (EMS) the goal of stroke care is to minimize brain injury and maximize recovery. The stroke chain of survival links actions taken by patients, family, EMS and healthcare providers. Recent innovations in stroke treatment require accurate identification and appropriate triage to the appropriate treatment facility. Evidence in the literature demonstrates variability with EMS correct identification of stroke patients between 30% and 80%. Our 164 bed primary stroke center in rural Pennsylvania has been active in providing stroke education on an annual basis to emergency medical services within a two county radius. As part of our ongoing process improvement we wanted to evaluate the emergency medical technicians and paramedics knowledge of stroke signs and symptoms, their understanding of the evaluation, treatment and triage of stroke patients. A standard questionnaire with 14 variables was developed using the American Heart and Stroke Association prehospital guidelines. The questionnaire included 16 stroke and non stroke symptoms, identifying transport to primary verses comprehensive stroke centers and initial evaluation. A sample population of 90 emergency medical service staff were asked to complete the questionnaire with 28 (31%) responses received. All participants indicated they were confident to recognize stroke signs and symptoms but 6 of the non stroke items were chosen as stroke symptoms. All participants indicated they were confident in the initial evaluation of a stroke patient but 14 (50%) appropriately identified airway, breathing, circulation as the first evaluation. Evaluating triage knowledge, 26 (93%) stated confidence in decision to transport to a primary stroke center and 22 (79%) to a comprehensive stroke center, however, appropriate decision to transport to a primary stroke center was identified correctly by 46% a comprehensive stroke center 66%. In conclusion, results from this study suggest that in this rural setting, barriers exist in prehospital recognition and evaluation of the stroke patient for which proper education may be remediable. Our goal is to use this information to revise our current EMS stroke education program and enhance prehospital assessment and triage.

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Impact of COVID-19 Pandemic on the Incidence, Prehospital Evaluation, and Presentation of Ischemic Stroke at a Nonurban Comprehensive Stroke Center

Stroke Research and Treatment ◽

10.1155/2021/6624231 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Cesar Velasco ◽

Brandon Wattai ◽

Scott Buchle ◽

Alicia Richardson ◽

Varun Padmanaban ◽

...

Keyword(s):

Urban Areas ◽

Stroke Care ◽

Final Diagnosis ◽

Medical Attention ◽

Presenting Symptoms ◽

Number Of Patients ◽

Community Transmission ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

The Impact

Introduction. Many reports have described a decrease in the numbers of patients seeking medical attention for typical emergencies during the COVID-19 pandemic. These reports primarily relate to urban areas with widespread community transmission. The impact of COVID-19 on nonurban areas with minimal community transmission is less well understood. Methods. Using a prospectively maintained prehospital quality improvement database, we reviewed our hospital EMS transports with a diagnosis of stroke from January to April 2019 (baseline) and January to April 2020 (pandemic). We compared the volume of patients, transport/presentation times, severity of presenting symptoms, and final diagnosis. Results. In January, February, March, and April 2019, 10, 11, 17, and 19 patients, respectively, were transported in comparison to 19, 14, 10, and 8 during the same months in 2020. From January through April 2019, there was a 53% increase in transports, compared to a 42% decrease during the same months in 2020, constituting significantly different trend-line slopes (3.30; 95% CI 0.48–6.12 versus -3.70; 95% CI -5.76–-1.64, p = 0.001 ). Patient demographics, comorbidities, and symptom severity were mostly similar over the two time periods, and the number of patients with a final diagnosis of stroke was also similar. However, the median interval from EMS dispatch to ED arrival for patients with a final diagnosis of stroke was significantly longer in January to April 2020 ( 50 ± 11.7 min ) compared to the same time period in 2019 ( 42 ± 8.2 min , p = 0.01 ). Discussion/Conclusion. Our data indicate a decrease in patient transport volumes and longer intervals to EMS activation for suspected stroke care. These results suggest that even in a nonurban location without widespread community transmission, patients may be delaying or avoiding care for severe illnesses such as stroke. Clinicians and public health officials should not ignore the potential impact of pandemic-like illnesses even in areas of relatively low disease prevalence.

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Abstract TP395: Completing Stroke Education Requirements for Comprehensive Stroke Center Certification

Stroke ◽

10.1161/str.48.suppl_1.tp395 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Georgann R Adams ◽

Belinda Wallbank

Keyword(s):

Stroke Patient ◽

Team Leadership ◽

Professional Staff ◽

Early Management ◽

Wide Range ◽

Stroke Education ◽

Education Requirements ◽

Radiology Technicians ◽

Comprehensive Stroke Center ◽

Stroke Center

Background: The Joint Commission outlines requirements for Comprehensive Stroke Centers (CSC) which includes 8 hours of stroke education for staff providing care to the complex stroke patient. This requirement was initially a hurdle due to unit budgets and staff time constraints. Innovation in providing types, methods and variety of stroke education helped bridge the gap and enabled a wide range of learning types to complete the education requirements and improve the care of the complex stroke patient. Methods: Stroke education was provided and tracked using an electronic learning management system (eLMS). Evidenced based stroke articles and guidelines were selected by stroke team leadership based upon a needs assessment completed by unit staff. Stroke lectures were recorded and added on targeted topics for new research evidence including the 2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment. Questions were developed to validate learning from the modules. Webinars and live sessions were offered in 1-4 hour time blocks as requested by staff and administrators limiting overtime for unit staff working 36 hours per pay period. A variety of staff were educated included nursing, social workers, care managers, radiology technicians, nursing assistants, and administrators. Results: Stroke education was provided to over 300 staff members in a flexible manner that included multiple learning styles, shifts and types of professionals to fulfill the requirements of providing 8 hours of stroke education annually at a Certified Comprehensive Stroke Center with minimal stress on unit budgets. Conclusion: Pertinent stroke education was provided to professional staff using multiple approaches, tracked by the hospital’s eLMS program thus improving stroke quality metric, staff understanding of those metrics and contributed to a successful CSC certification and recertification.

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Abstract MP24: Pitfalls of Mobile Stroke Treatment Unit - A Single Center Review

Stroke ◽

10.1161/str.52.suppl_1.mp24 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Mangala Gopal ◽

Ciaran Powers ◽

Shahid M Nimjee ◽

Sharon Heaton ◽

Vivien Lee

Keyword(s):

Intravenous Thrombolysis ◽

Stroke Care ◽

Final Diagnosis ◽

Acute Stroke Care ◽

Treatment Unit ◽

Stroke Treatment ◽

The Mean ◽

Suspected Stroke ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Although Mobile Stroke Treatment Units (MSTU) can reduce time to intravenous thrombolysis (IVtPA), limitations in MSTU care have not been well described. Methods: We retrospectively reviewed consecutive patients transported by MSTU to our academic comprehensive stroke center (CSC) from May 2019 to August 2020 for suspected stroke to assess for potential limitations of care. The Columbus MSTU is owned by a separate health system, but represents a collaborative venture with 3 CSCs and the Columbus Division of Fire, operating daily from 7am-7pm. Data was abstracted on demographics, clinical presentation, last known normal (LKN) time, initial National Institutes of Health Stroke Scale (NIHSS), neuroimaging, and IVtPA administration. Results: Among 93 patients transported to our CSC by MSTU, the mean age was 65 years (range, 21-93) and 61 (66%) were female. The mean initial NIHSS was 7.1 (range, 0 to 33) and 52 (55.9%) had a final diagnosis of stroke (4 hemorrhagic, 48 ischemic). IVtPA was administered in 15 (16.1%) with a mean LKN to IVtPA time of 120 minutes (range, 41 to 243). Among 15 patients treated with IVtPA, 10 received IVtPA in MSTU and 5 in CSC ED. In 7 patients who underwent thrombectomy, mean door to groin time was 57 minutes (range, 28 to 88). Among the overall group, 9 (9.7%) cases were identified with limitations in MSTU care, including 2 patients who received IVtPA by MSTU that were more than 10% off from ideal dosing (underdosed by 9mg and overdosed by 21mg), 1 warfarin-associated hemorrhage requiring intubation who did not receive reversal in MSTU but did upon arrival to CSC ED, and 5 patients who received IVtPA after arrival to CSC ED. The reasons for withholding IVtPA included inability to confirm LKN, patient declination, lack of translator, incorrect LKN, and seizure requiring intubation. The LKN to IVtPA time was significantly longer in the ED compared to MSTU (197 vs 82 minutes, p <0.0001). Conclusion: In our series of suspected stroke patients evaluated by MSTU, gaps identified within MSTU acute stroke care were related to limitations of resources and included errors in weight-based IVtPA dosing, inability to administer IVtPA, or reversal for anti-coagulation related hemorrhage. Clinicians need to be aware of potential pitfalls of MSTU evaluation.

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Abstract TP368: The Impact of Hospital Based Specialist Physicians Conducting Post-Discharge Follow-Up Phone Calls at a Comprehensive Stroke Center

Stroke ◽

10.1161/str.51.suppl_1.tp368 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Cynthia Sinogui ◽

Yogesh Nandan ◽

Amber Jennings ◽

Pat Zrelak

Keyword(s):

Acute Care ◽

Nursing Facilities ◽

Post Discharge ◽

Skilled Nursing ◽

Secure Messaging ◽

Phone Calls ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

The Impact

Background: As a Comprehensive Stroke Center (CSC), The Joint Commission requires post-discharge follow-up phone calls to be conducted within 7 days of discharge for all complex stroke patients. Purpose: To develop and sustain a feasible approach for Hospital Based Specialist (HBS) physicians to conduct follow-up phone calls within 7 days. Methods: A baseline evaluation of all post-discharge phone calls was conducted. It was determined that patients were receiving several phone calls already, therefore the team did not want to add an additional call to meet compliance. HBS calls were realigned to include a stroke-specific focus, reinforcing stroke education and secondary prevention. Calls were made within 7 days by the discharging physician. All stroke patient types discharged with a stroke diagnosis were contacted regardless of severity. Patients discharged to skilled nursing facilities, board and care, acute rehabilitation or other acute care hospitals were excluded. A templated note was developed to ensure all stroke-specific components were covered. All HBS physicians were trained. Telephone interactions occurred between the patient, family member, and/or caregiver. Those unable to be reached but had messages left or secure messaging sent were counted as compliant. Reminders were sent out to physicians to improve call compliance. Tracking occurred weekly for call compliance and note template utilization. Results: Between January 2018 and May 2019, 612 patients discharged home from the acute care setting. Of those, 55% (334) were contacted. Of those, 73% had the templated note documented. Several hurdles were encountered along the way, but utilization of the templated note and physician reminders improved compliance. Conclusion: Post-discharge follow-up phone calls initiated by HBS physicians and utilization of a templated note are a feasible means of meeting and sustaining the CSC requirement.

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Prehospital Triage Accuracy in Patients With Stroke Symptoms Assessed Within 6 to 24 Hours or With an Unknown Time of Onset

Stroke ◽

10.1161/strokeaha.120.033676 ◽

2021 ◽

Vol 52 (4) ◽

pp. 1441-1445

Author(s):

Tove Almqvist ◽

Annika Berglund ◽

Christina Sjöstrand ◽

Einar Eriksson ◽

Michael V. Mazya

Keyword(s):

High Specificity ◽

High Likelihood ◽

Vessel Occlusion ◽

Triage System ◽

Hospital Patients ◽

Primary Stroke Center ◽

Prehospital Triage ◽

Suspected Stroke ◽

Comprehensive Stroke Center ◽

Stroke Center

Background and Purpose: The Stockholm Stroke Triage System, implemented in 2017, identifies patients with high likelihood of large vessel occlusion (LVO) stroke. A previous report has shown Stockholm Stroke Triage System notably reduced time to endovascular thrombectomy (EVT). As the indication for EVT now includes patients up to 24 hours, we aimed to assess Stockholm Stroke Triage System triage accuracy for LVO stroke and EVT treatment for patients presenting late (within 6-24 hours or with an unknown onset), put in contrast to triage accuracy within 0 to 6 hours. Methods: Between October 2017 and October 2018, we included 2905 patients with suspected stroke, transported by priority 1 ground ambulance to a Stockholm Region hospital. Patients assessed 6 to 24 hours from last known well or with unknown onset were defined as late-presenting; those within <6 hours as early-presenting. Triage positivity was defined as transport to comprehensive stroke center because of suspected stroke, hemiparesis and high likelihood of EVT-eligible LVO per teleconsultation. Results: Overall triage accuracy was high in late-presenting patients (90.9% for LVO, 93.9% for EVT), with high specificity (95.7% for LVO, 94.5% for EVT), and low to moderate sensitivity (34.3% for LVO, 64.7% for EVT), with similar findings in the early-presenting group. Conclusions: Our results may support using the Stockholm Stroke Triage System for primary stroke center bypass in patients assessed by ambulance up to 24 hours from time of last known well.

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Abstract TP286: Improving Core Measure Compliance in Stroke Chameleon Patients

Stroke ◽

10.1161/str.48.suppl_1.tp286 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Michele Gribko ◽

Ann Marie McLeod ◽

Richard B Libman ◽

Paul Wright ◽

Jeffrey M Katz

Keyword(s):

Statistical Significance ◽

Altered Mental Status ◽

Post Intervention ◽

Vte Prophylaxis ◽

Radiology Reports ◽

Stroke Diagnosis ◽

Stroke Education ◽

Using Data ◽

Comprehensive Stroke Center ◽

Stroke Center

Background: Patients presenting with altered mental status, syncope, and other non-localizing complaints may be subsequently diagnosed with minor ischemic or hemorrhagic strokes. These patients, termed stroke chameleons, are typically admitted to non-neurology units (NNUs) with a non-stroke diagnosis and are more likely to fall-out on stroke core measures (SCM). Early identification of these patients should improve SCM compliance and promote better care. Methods: A performance improvement initiative was implemented to elevate SCM compliance overall by targeting patients admitted to NNUs in a comprehensive stroke center. A nurse practitioner was dedicated to scan the electronic medical record for potential stroke chameleons on NNUs and review radiology reports to confirm a stroke diagnosis. A SCM checklist was utilized to reinforce SCM adherence with the patient’s providers and nurses. SCM compliance for 24 months pre and 12 months post intervention was compared using data entered into the Get With The Guideline-Stroke database. Results: Over the 3-year study period, 3,355 patients were discharged with a stroke diagnosis. Comparing pre to post intervention periods, 522/2129 (24.5%) vs. 401/1226 (32.7%) patients were admitted to NNUs. Distribution of pre- and post intervention stroke diagnoses were ischemic/TIA 381 (73.0%) vs. 319 (79.6%) and hemorrhagic 141 (27.0%) vs. 82 (20.4%). For NNU patients, the initiative had a statistically significant impact on stroke education documentation (45.5% pre vs. 67.0% post; p=0.0006). In addition, compliance improved for smoking cessation (77.8% to 81.2%), early antithrombotics (84.0% to 85.3%), VTE prophylaxis (90.8% to 94.7%), and discharge antithrombotic therapy (98.7% to 100%), although none were statistically significant. Conclusion: Dedicating resources to identify stroke chameleons early, and focusing compliance efforts on NNUs, significantly improved compliance with stroke education. Other SCM showed numerical improvements, but did not reach statistical significance. Especially in centers with high volumes of stroke chameleons, attention and efforts directed at this population raises the quality of care provided to all hospitalized stroke patients.

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Abstract P113: Impact of Covid-19 Pandemic on the Pre-Hospital Evaluation and Presentation of Ischemic Stroke at a Non-Urban Comprehensive Stroke Center

Stroke ◽

10.1161/str.52.suppl_1.p113 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Cesar Velasco ◽

Alicia M Richardson ◽

Varun Padmanaban ◽

Raymond K Reichwein ◽

Ephraim Church ◽

...

Keyword(s):

Urban Areas ◽

Stroke Care ◽

Final Diagnosis ◽

Medical Attention ◽

Severe Illness ◽

Presenting Symptoms ◽

Community Transmission ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

The Impact

Introduction: Many reports have described a decrease in the numbers of patients seeking medical attention for typical emergencies during the COVID-19 pandemic. These reports primarily relate to urban areas with widespread community transmission. The impact of COVID-19 on non-urban areas with minimal community transmission is less well understood. Methods: Using a prospectively maintained pre-hospital quality improvement database, we reviewed our hospital EMS transports with a diagnosis of stroke from January to April 2019 (baseline) and January to April 2020 (pandemic). We compared the volume of patients, transport/presentation times, severity of presenting symptoms, and final diagnosis. Results: In January, February, March, and April 2019 10, 11, 17 and 19 patients, respectively were transported in comparison to 19, 14, 10 and 8 during the same months in 2020. From January through April 2019 there was a 53% increase in transports, compared to a 42% decrease during the same months in 2020. The slopes of these trend lines are significantly different (3.30; 95%CI 0.48 - 6.12 versus -3.70; 95%CI -5.76 - -1.64, P = 0.001). There were no significant differences in demographics, comorbidities, symptom severity, or stroke discharge diagnoses between the two time periods. However, the median interval from LKW to time of EMS dispatch was significantly longer in January to April 2020 (12 + 273 min) compared to the same time period of January through April in 2019 (7 + 115 min). Conclusion: Our data indicate not only a decrease in patient transport volumes but more alarmingly, significantly longer intervals to EMS activation for suspected stroke care. These results suggest that even in a non-urban location without widespread community transmission patients were delaying or avoiding care for severe illness such as stroke.

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Abstract TP360: Triage Nursing Intervention Improves Stroke Treatment Rate and Times for Walk-In Strokes

Stroke ◽

10.1161/str.51.suppl_1.tp360 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Nayive Quezada ◽

Ron Burke ◽

Yaima Miro Gonzalez ◽

Maygret Ramirez ◽

Ivis C Gonzalez ◽

...

Keyword(s):

Rapid Assessment ◽

Community Outreach ◽

Nursing Intervention ◽

Treatment Rate ◽

Stroke Treatment ◽

Response Team ◽

Emergency Department Triage ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

One Year

Introduction: Our comprehensive stroke center provides community outreach and stroke education to patients, caregivers, and community members on the importance of calling 911 in the event of a stroke. However, approximately 1/3 of our center’s stroke alerts are walk-ins. With a walk-in stroke, rapid assessment is essential because the stroke response team has no information compared to information that otherwise would be provided by EMS. As such, our center developed a rapid assessment by the emergency triage nurse or technician, who can then activate a stroke alert. Methods: The change to rapid stroke assessment and stroke alert activation by triage nurses and technicians (rather than waiting for an emergency physician to assess and activate a stroke alert) was made in March 2018. Cases from one year prior to the intervention were compared to cases from the year after implementation. Differences in turnaround times (door to stroke alert activation, door to needle [DTN]) were calculated. Results: In the period before implementation, there were 1200 stroke alerts, of which 420 arrived via triage (35%). Median door to stroke alert was 0 min. Of those who arrived through triage, 8 received IV alteplase (8/420=2%). For those patients, median DTN was 39 min. In contrast, after implementation, there were 1401 stroke alerts, of which 342 arrived via triage (24%). Median door to stroke alert was 2 min. Of those, 15 received IV alteplase (15/342=4%), with a median DTN of 32 min. Discussion: A nursing driven initiative at Emergency Department triage was effective at improving stroke treatment rate and decreasing DTN for IV alteplase for walk-in stroke patients.

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Value of repeated imaging in patients with a stroke who are transferred for endovascular treatment

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017050 ◽

2021 ◽

pp. neurintsurg-2020-017050

Author(s):

Laura C C van Meenen ◽

Nerea Arrarte Terreros ◽

Adrien E Groot ◽

Manon Kappelhof ◽

Ludo F M Beenen ◽

...

Keyword(s):

Endovascular Treatment ◽

Clinical Improvement ◽

Treatment Delay ◽

Clinical Deterioration ◽

Large Vessel Occlusion ◽

Intracranial Hemorrhages ◽

Vessel Occlusion ◽

Quality Outcomes ◽

Comprehensive Stroke Center ◽

Stroke Center

BackgroundPatients with a stroke who are transferred to a comprehensive stroke center for endovascular treatment (EVT) often undergo repeated neuroimaging prior to EVT.ObjectiveTo evaluate the yield of repeating imaging and its effect on treatment times.MethodsWe included adult patients with a large vessel occlusion (LVO) stroke who were referred to our hospital for EVT by primary stroke centers (2016–2019). We excluded patients who underwent repeated imaging because primary imaging was unavailable, incomplete, or of insufficient quality. Outcomes included treatment times and repeated imaging findings.ResultsOf 677 transferred LVO stroke, 551 were included. Imaging was repeated in 165/551 patients (30%), mostly because of clinical improvement (86/165 (52%)) or deterioration (40/165 (24%)). Patients who underwent repeated imaging had higher door-to-groin-times than patients without repeated imaging (median 43 vs 27 min, adjusted time difference: 20 min, 95% CI 15 to 25). Among patients who underwent repeated imaging because of clinical improvement, the LVO had resolved in 50/86 (58%). In patients with clinical deterioration, repeated imaging led to refrainment from EVT in 3/40 (8%). No symptomatic intracranial hemorrhages (sICH) were identified. Ultimately, 75/165 (45%) of patients with repeated imaging underwent EVT compared with 326/386 (84%) of patients without repeated imaging (p<0.01).ConclusionsNeuroimaging was repeated in 30% of patients with an LVO stroke and resulted in a median treatment delay of 20 minutes. In patients with clinical deterioration, no sICH were detected and repeated imaging rarely changed the indication for EVT. However, in more than half of patients with clinical improvement, the LVO had resolved, resulting in refrainment from EVT.

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