Introduction With the success of endovascular stroke therapy (EST), eligible acute ischemic stroke (AIS) patients must be appropriately screened. CT Perfusion (CTP) was the predominant imaging technique used to identify candidates in the recent trials of EST. However, the real-world utilization and availability of CTP is unknown.
Methods Patients with AIS were identified by validated diagnosis codes from data on all discharges from hospitals and Emergency Departments (EDs) in Florida (FL, 2012 – 2016) and New York (NY, 2012–2014). The primary endpoint was ED imaging utilization, defined by the corresponding billing codes. CTP or EST-capable hospitals were defined as those performing at least one CTP or EST in the corresponding calendar year. Trends over time and by region were compared.
Results In the FL cohort, among 226,051 admissions for stroke at 285 hospitals, median age was 72 [IQR 61–82] and 113,489 (50%) were female. 14,920 (7%) received IV tPA and 3,026 (1.3%) received EST. Nearly all strokes were treated at CTA and MRI-capable EDs, but 139,316 (62%) were treated at non-CTP-capable hospitals (figure 1). 28 (60%) of EST-capable hospitals were not CTP-capable, a trend that did not change over the study period (figure 2). In the NY cohort, among 91,193 admissions for stroke at 225 hospitals, 71,333 (78%) were evaluated at non-CTP-capable centers. 30 (13%) of hospitals treating AIS patients were CTP-capable. CTP-capable centers were concentrated in urban areas, with significant annual stroke rates in non-urban areas without CTP.
Conclusions In this large cohort study, the majority of AIS patients and EDs treating AIS did not have access to CTP, a finding that did not immediately increase following 2015 trials. Use of CTP as a universal screening tool for EST may still be limited. Non-contrast CT remains the most important screening tool for EST in AIS patients under 6 hours from symptom onset.
Disclosures A. Czap: None. S. Lee: None. V. Lopez-Rivera: None. J. Grotta: None. P. Chen: None. S. Blackburn: None. L. Giancardo: None. S. Savitz: None. L. McCullough: None. A. Bambhroliya: None. F. Vahidy: None. S. Sheth: None.
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