Introduction Endovascular therapy has revolutionized acute stroke management associated with large vessel occlusion (LVO). The province of Saskatchewan currently has 8 primary stroke centers (PSC) and 1 comprehensive stroke center (CSC) spread over a large geographical area. Seventy three percent of the population lives outside the Saskatoon metropolitan area, which houses the province’s single comprehensive stroke centre. Geography remains a significant barrier to providing endovascular therapy in a timely manner to eligible patients, knowing that the time to recanalization is a vital variable in clinical outcome. We aim to quantify the distance and time to transfer of patients to the CSC, and determine factors associated with clinically significant evolution of infarct during transfer.
Methods We completed a retrospective analysis of all acute stroke patients with LVOs who were transferred from PSCs to the CSC for possible endovascular therapy in Saskatchewan from July 2016 – July 2018. Along with patient, imaging, and outcome specific factors, detailed transfer data including modality, time, and distance were collected.
Results Forty-seven patients were identified as having had a LVO diagnosed at a PSC, with subsequent transfer to the CSC for endovascular therapy. The average age was 70.6 years. Of these patients, 13 (28%) underwent EVT, while 34 patients did not: 7 (15%) had clinical improvement, 12 (25%) had vessel recanalization on repeat CTA, and 15 (32%) had ASPECTS decay leading to EVT ineligibility. Distance to the PSC and distance from PSC to CSC were the most significant contributors to ASPECTS decay.
Conclusion Rates of ineligibility due to ASPECTS decay were similar to those found in other regional data, despite significantly greater distances. Since the large geographic area covered by the CSC leads to a significant cost burden associated with transfers, we aim to optimize transfer protocols to better serve the outlying areas.
Disclosures S. Ahmed: None. E. Noyes: None. K. Whelan: None. B. Graham: None. G. Hunter: None. M. Kelly: None. L. Peeling: None.
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