Are physicians more vigilant in recognizing acute Posterior Circulation Stroke symptoms? - Experience of a Tele-stroke Network. (S21.007)

OBJECTIVE: Compare IV tPA use in MRI proven anterior circulation versus posterior circulation strokes. BACKGROUND: Potential delay in early diagnosis of posterior circulation ischemic strokes would result in fewer intravenous tPA administrations compared to anterior circulation strokes. DESIGN/METHODS: A retrospective analysis of patients admitted to a large volume primary stroke center was conducted. HIPPA compliant data consisting of history and physicals, consults, ED notes, radiology evaluations, lab results and pharmacy orders were mined using a patented methodology called Process Arbitrage. Patients with MRI proven DWI changes were manually screened and divided into three categories: anterior circulation, posterior circulation and multiple strokes affecting both circulations were included. SAS statistical package was used. Proportions of patients in each category receiving tPA were calculated. Reasons for not receiving tPA were also assessed. RESULTS: A total of 160 patients had acute ischemic strokes that were confirmed by MRI scanning. Of these patients, 105 (65.6[percnt]) infarcts were exclusively in the anterior circulation, 35 (21.9[percnt]) infarcts were exclusively in the posterior circulation and 20 (12.5[percnt]) patients had multiple acute infarcts involving both the anterior and posterior circulations. Of 160 patients, 40 (25.0[percnt]) received intravenous tPA. Among patients with anterior circulation infarcts, 26 (24.8[percnt]) received tPA. Among patients with posterior circulation infarcts 12 (34.3[percnt]) received tPA. Two of the patients (10.0 [percnt]) with multiple infarcts involving both circulations received tPA. The proportions of patients with exclusively anterior and posterior circulation infarcts receiving tPA were not significantly different (Fisher’s test p value: 0.28). CONCLUSIONS:In spite of the potential for delay in diagnosis, posterior circulation infarcts receive intravenous tPA as frequently as anterior circulation infarcts. This is probably the result of a high degree of awareness and vigilance on the part of emergency room and stroke physicians for the correct assessment of patients with atypical posterior circulation symptoms. Disclosure: Dr. Madhavan has received personal compensation for activities with Process Proxy Corporation as a consultant. Dr. Bhattacharya has nothing to disclose. Dr. Nandanwar has nothing to disclose. Dr. Basha has nothing to disclose. Dr. Abhishek has nothing to disclose. Dr. Rajamani has nothing to disclose.