Abstract TP32: Predictors of Endovascular Treatment Among Stroke Codes Activated Within 6 Hours From Symptom Onset


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Abstract

Introduction: Prehospital stroke code activations help reducing wokflow times during in-hospital triage. We aim to identify predictors of endovascular treatment among activated stroke codes (ASC) within 6 hours from symptom onset.Methods: CICAT is a prospective official mandatory registry of all ASC in Catalunya. We studied all CICAT entries from 5 comprehensive stroke centers during 18 months.We recorded demographic, historic, clinical and imaging variables on admission. We explored the relationship between these variables and endovascular treatment (EVT)Results: From 3944 ASC, 2818 (71.5%) were admitted < 6 hours from symptom onset. Mean age was 72±15.3 years, median RACE scale 4 (IQR 2-6), median onset-to-door time (OTDT) was 87 minutes (IQR 54-158), median NIHSS score 9 (IQR 4-18), median ASPECTS 10 (IQR 8-10. Final diagnosis was ischemic stroke in 1767 patients (62.7%), hemorrhagic stroke in 364 (12.9%), TIA in 167 (5.9%), stroke-mimic in 500 (17.7%). After admision a large vessel occlusion (LVO) was confirmed in 916 (23.2%) patients. While the rate of ASPECTS ≥ 9 among ischemic strokes progressively decreased over time (0-3h: 73.2% vs 3-6h: 57.1%: p<0.01), the rate of ASPECTS ≥6 (0-3h: 95.1% vs 3-6h: 91.6%: p=0.13) and presence of LVO (0-3h: 22.4% vs 3-6h: 22.8%: p=0.82) did not decrease over time. Of all ACS, 16% (n=453) received EVT, with a median door to groin time of 77 minutes (IQR 55-102). Baseline variables independently associated with EVT were premorbid mRS>2 (p<0.001), prehospital RACE score >4 (p=0.003) and NIHSSon admission >8 (p<0.001). The chances to receive EVT were similar in patients admitted 0-3 (16.4%) Vs. 3-6 hours (14.6; p=0.3). ASC with a RACE score>4 had 26.0% probability to receive EVTConclusion: Among ACS within 6 hours from symptom onset, time from onset to arrival is not associated with the probability of receiving EVT. Only 5% of these patients show an ASPECTS <6 and this rate does not significantly increase during the first 6 hours. These data may be useful to generate direct transfer to angio-suite protocols.

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