Abstract TP312: Direct Visits to Comprehensive Stroke Centers Reduce Time Delays for Thrombolytic Therapy in Acute Ischemic Stroke

Background and Purpose The benefits of thrombolytic therapy for the treatment of acute ischemic stroke are time-dependent. However, many hospitals are not capable of performing endovascular thrombectomy, so patients are often transferred to comprehensive stroke centers, resulting in a delay of treatment. We evaluated the differences in time to thrombolytic therapy between directly admitted patients and referred patients. Methods: Between July 2014 and February 2018, 382 patients (mean age: 69.0±11.4 years; men: 52.5%) who received thrombolytic therapies within specified therapeutic time windows were included in this study. We identified stroke patients who received intravenous tissue plasminogen activator within 4.5 hours and/or endovascular thrombectomy within 6 hours of symptom onset. We divided the patients into two groups - those who presented to our center directly, and those who were referred from outside hospitals. Baseline characteristics and time variables were compared between the two groups, and we also evaluated the factors associated with favorable outcomes at 3 months. Results: A total of 108 (28.2%) patients were referred from other hospitals, whereas 275 (71.8%) patients presented to our hospital directly. Direct visit patients received thrombolytic therapies faster than the referred group, according to the onset-to-needle time (126 vs. 163 minutes, p < 0.001) and onset-to-puncture time (194 versus 226 minutes, p < 0.001). Younger age (odds ratio (OR) 0.94; 95% confidence interval (CI) 0.92-0.97; p<0.001), lower National Institutes of Health Stroke Scale (NIHSS) score (OR 0.86; 95% CI 0.82-0.90; p<0.001), and direct presentation to the stroke center (OR 1.75; 95% CI 1.02-3.03; p=0.044) were independently associated with favorable outcomes at 3 months. Conclusions: Bypassing local hospitals to present directly to the comprehensive stroke center reduced time delays for thrombolytic therapies and improved favorable outcomes in patients with acute ischemic stroke.