Decade-Long Trends In Recanalization Therapy At A Large Regional Comprehensive Stroke Center In Texas

Introduction: Recanalization therapy (RT) is the cornerstone of acute ischemic stroke (AIS) management. We present 10-year trend in RT at our center, and explore effects of increasing telemedicine (TM) access and a Mobile Stroke Unit (MSU). Methods: We identified suspected AIS patients between 01/01/2007-12/31/2016 from our prospectively managed registry. Patients presented directly (DP), were transferred-in (TP) from a regional referring hospital with or without TM consultation, or via the MSU. Pre-established TM/MSU period was from 01/01/2007-12/31/2011. We used logistic regression to explore temporal trends among patient groups, report odds ratios (OR) with 95% confidence intervals, and quantile regression to determine the difference in median (DIM) treatment times. Results: We reviewed 9,464 suspected AIS cases. 44.8% were in pre-TM/MSU and 55.2% TM/MSU period. Over 10 years, the proportion of DP has significantly reduced [OR 0.84 (0.83-0.86)], whereas non-TM TP has increased [OR 1.05 (1.03-1.06)]. In TM/MSU period, the proportion of TM patients has significantly increased each year [OR 2.00 (1.85-2.16)]. Fig. 1 shows the proportional distribution. 29.3% of patients were treated with tPA; significantly higher during the TM/MSU period compared to pre-TM/MSU [(31.5% vs 21.5%, OR 1.21 (1.11 - 1.33)]. Median onset to needle time was significantly shorter for the TM/MSU period [140(99-193) vs 157(119-198), DIM -17(-10.7,-23.2)], as was the proportion of symptomatic intracranial hemorrhage (sICH) [(1.7% vs 4.2%), OR 0.40(0.25-0.64)]. With each increasing year, a significantly greater proportion of patients were discharged home after controlling for age and NIHSS [OR 1.12 (1.10-1.14)]. Conclusion: Over a decade, we saw a steady increase in proportion of tPA treated cases. With the introduction of TM and the MSU at our institution, more AIS patients received RT, with faster onset to treatment, fewer sICH complications, and improved discharge disposition.