Abstract TP248: Vascular Neurologists Increase the Frequency of Intravenous Thrombolytic Administration

Background: It is estimated that only 1-3% of ischemic stroke patients receive IV r-tPA. There are multiple reported barriers that impede the administration of IV-tPA in ischemic stroke patients. However, one specific barrier continually cited by emergency room physicians is a lack of neurological support. In addition, many general neurologists do not regularly treat stroke patients, and therefore do not feel comfortable administering IV r-tPA. We sought to determine if 24/7 availability of vascular neurologists either at the bedside or via telemedicine would increased the frequency IV r-tPA administration in a local community hospital compared to general neurologists via phone consultation. Methods: We reviewed the stroke database and determined how many patients presenting with an acute ischemic stroke received IV r-tPA within 4.5 hours during the 14 months before and the 14 months after the implementation of 24/7 vascular neurology availability. We also collected patient age, time of onset, time of arrival, and NIH stroke scale. The student’s t-test or Fisher’s exact test was used to calculate p values for significance when appropriate. Results: Between January 1, 2010 and March 22, 2011, 408 stroke emergencies were activated and 7 patients received IV r-tPA under the consultation of general neurologists. Between March 23, 2011 and May 27, 2012, 291 stroke emergencies were activated and 39 patients received IV r-tPA under the consultation of vascular neurologists (1.7% vs. 13.4%, p<0.0001). The mean NIHSS for patients that received IV r-tPA before the 24/7 vascular neurology availability was 11.80, and the mean NIHSS for patients that received IV r-tPA after the 24/7 vascular neurology availability was 13.86 (p=0.61). In 2012, a change in the time window criteria of when to activate an acute stroke emergency decreased the number of stroke emergencies recorded in the second half of the database. Conclusion: The 24/7 availability of vascular neurologists increased the IV r-tPA administration rate by more than 5 fold. Access to stroke expertise significantly improves the number of ischemic stroke patients that receive IV r-tPA within 4.5 hours.