Abstract 1122‐000137: Characteristics and Utilization of Acute Reperfusion Therapy after Transfer of In‐Hospital LVO Strokes

Introduction : Acute repercussion therapy for acute ischemic stroke is a crucial tool in the tertiary care setting for patients presenting with large vessel occlusion (LVO). While strokes that present from the community have favorable outcomes compared to in‐hospital strokes, it is unclear if this is because of greater access to endovascular therapy. We aim to characterize the utilization of endovascular reperfusion therapy for in‐house LVO and compare outcomes of in‐house LVOs to those presenting from the community. Methods : From the period of December 2013 to December 2019, all stroke patients with an LVO who presented to a primary stroke center (“spoke” hospital) who were transferred to a comprehensive stroke center (“hub”) were analyzed. Univariate and multivariate analyses were performed to compare baseline characteristics and clinical outcomes. Results : A total of 181 in‐house strokes were transferred from a peripheral center to our comprehensive stroke center. About 16% (29) received IV‐tPA at the OSH and 2 additional patients received IV‐tPA at the CSC [17%; n = 31]. 163 patients harbored an intracranial acute vessel occlusion. Anterior LVO (ICA, M1,M2) and basilar artery occlusion was observed in 64% (n = 116) patients and 6% (n = 11) patients, respectively [Total LVO‐ 70%; n = 127]. 20% (n = 27) of LVO received IV‐tPA and 72% (n = 91) of LVO underwent thrombectomy. Reasons for not receiving included symptoms improved (25%), repeat imaging made reperfusion inadvisable (72.2%) and poor baseline (2.8%). Rates of mRS 0–2 in patients with ICA/M1/M2 receiving EVT were 13% (13/100) and the mortality rate was 45% (46/103). Rates of mRS 0–2 were significantly lower [13% vs 38%, p<0.01] and mortality was significantly higher [45% vs 18%, p<0.01] amongst anterior LVO in‐house transfer patients receiving EVT compared to all anterior LVO patients receiving EVT in the given time period. Conclusions : A relatively large proportion of in‐house LVO stroke patients underwent thrombectomy (70%). Most common cause of not receiving thrombectomy was imaging findings showing completed or large infarct. Compared to their community stroke counterparts, in‐house LVO strokes had lower efficacy outcomes and higher mortality. Further study in required to understand these findings.