Abstract P180: Protocolized Selection for Telestroke Activation in The Extended Window for Thrombectomy

The advent of biomarker-driven identification of candidates for acute therapies in the 4.5-24-hour time window has resulted in an increase in the number of telestroke consults with low yield for acute intervention. While the use of the Vision Aphasia Neglect (VAN) score and a National Institutes of Health Stroke Scale (NIHSS) cutoff score of ≥6 may help identify patients with Large Vessel Occlusions (LVO), there are no guideline-based protocols for using these scales as a decision point for telestroke activation. We selected 5 spoke sites from an academic hub-and-spoke model telestroke network for inclusion in our study. In the extended window (4.5-24 hours), telestroke consultants assisted with appropriate selection for hospital transfers for mechanical thrombectomy (MT) with the goals of maximizing retention at the spoke sites. All sites were able to obtain computed tomography angiography (CTA) head and neck onsite. In the extended window, the following protocols were followed at the sites for telestroke activation: Sites A - B: NIHSS ≥6; Site C: NIHSS ≥6 and/or VAN positive; Sites D - E any acute-onset, focal neurological symptoms within 24 hours of symptom onset. Descriptive statistics were used. Between July 2019 and February 2020, there were 1,114 telestroke consults with 351 (32%) extended window activations. In the extended window, the number of activations for NIHSS≥6 was less than a third of the total activations and the rate of transfer for MT was low across the sites regardless of whether the sites had adopted a protocolized activation (Table). However, 80% of all transfers had an NIHSS ≥6. In an academic telestroke network, protocols for selecting “high-yield” consults in the extended thrombectomy window did not lead to less telestroke activation or a higher yield for MT. More studies are needed to determine if this is due to the applied scales or whether targeted educational interventions at the sites would improve selection.

Duke Scholars

Author Elizabeth A. Marriott Hospital Neurology

Author Brian C. Mac Grory Neurology, Stroke and Vascular Neurology

Author Scott Mayhugh Le Neurology, Stroke and Vascular Neurology