Abstract 1122‐000179: Very Low Rates of Intracerebral Hemorrhage in Patients Transferred for Mechanical Thrombectomy
Introduction : Background: A common convention among stroke patients being transferred for mechanical thrombectomy, particularly if intravenous thrombolysis has been given, is to undergo a repeat plain brain CT at the treating stroke center. The most concerning among several concerns is the discovery of intracerebral hemorrhage (ICH) which would obviate the value of thrombectomy. This practice has been shown in a previous series to result in a median treatment delay of 20 minutes[1]. By determining the actual incidence of any ICH seen on neuroimaging in patients who undergo repeat imaging on arrival to comprehensive stroke center prior to intervention, we can better determine the true value of this convention of repeat imaging. Methods : Retrospective review of all patients transferred to a single academic comprehensive stroke center for mechanical thrombectomy. We evaluated for the frequency of repeat imaging, the rate of ICH and the rate of undergoing mechanical thrombectomy. Results : There were 682 patients transferred directly for mechanical thrombectomy evaluation over the study period. Intravenous Alteplase was administered to 391 patients prior to arrival and 2 had it on arrival to destination hospital. Plain head CT was repeated at the hub hospital in 590/682 patients (86.5%) (348 with thrombolytics and 242 without. A new intracerebral hemorrhage (ICH) was detected in 9 patients. In only 3 of the 9 patients was mechanical thrombectomy deferred solely due to the ICH (other 6 had no evidence of LVO (4), low ASPECTS (1) or exam improvement (1)). Conclusions : In patients being transferred for mechanical thrombectomy, the rate of ICH on arrival to site hospital was 1.5%. In only one third of those patients (0.5%) was the decision to not proceed with mechanical thrombectomy related to the new ICH. Given the delays in door to puncture times associated with repeat imaging indicated in literature and the low yield in detecting ICH in transfer patients, repeating neuroimaging at comprehensive stroke center obtained for the purpose of ruling out ICH on patients transferred for MT should be reconsidered. Limitations: Our study reflects a single center experience. Other indications for repeat imaging at comprehensive stroke center such as assessment of infarcted core, and presence of large vessel occlusion might still warrant repeat imaging at comprehensive stroke center.