Abstract TP288: Spoke hospital presentation does not significantly impact thrombectomy outcome

BACKGROUND: Thrombectomy improves outcome in large vessel occlusion acute ischemic stroke (LVO AIS), but, thrombectomy is not uniformly available. Many health systems have adopted a stroke system hub and spoke topology. Spoke sites provide rapid evaluation for intravenous thrombolysis before transfer for thrombectomy. Concern exists whether this evaluation may adversely affect outcomes. Bypassing non-thrombectomy capable hospitals for suspected LVO AIS patient has been proposed. This study compares outcomes between thrombectomy patients arriving directly at the hub and those presenting to spoke sites within our system. DESIGN/METHODS: We reviewed consecutive LVO AIS thrombectomy patients at our system between 2017 and 2022. Patients were stratified into those arriving at a spoke site versus those arriving at the hub. Groups were sub-stratified into those receiving TNKase, tPA, or no iv thrombolytic. Clinical, demographic, and outcome data were compared. RESULTS: We included 420 patients (245 (58%) arriving at the hub site and 174 (42%) arriving at a spoke site). Baseline characteristics, presenting NIHSS (16 vs 17, p=0.75), and interval from last known well to needle (115.5 minutes vs 131.1 minutes, p=0.08) were similar. Arrival at initial hospital to groin puncture (130.5 minutes at hub vs 188.2 minutes at spoke, p=<.0001) and to recanalization (181.1 minutes at hub vs 232.5 minutes at spoke, p=0.001) were significantly different. However, no significant difference existed between the LKW and reperfusion times in the hub arrival and spoke arrival groups (454.0 minutes at hub vs 465.1 minutes at spoke, p=0.78). Moreover, there was no significant difference in outcome metrics between groups: Median 24h-NIHSS of 12 in both groups, (p=0.81); median 3-m MRS of 3 in both groups (p=0.55); TICI 3b or better 84.7% for hub vs 86.1% for spoke, (p=0.71); 3-m MRS 0-2 40.3% for hub vs 41.8% for spoke, (p=0.76); and length of stay 9.8 for hub vs 10.5 days for spoke, (p=0.62). CONCLUSIONS: A spoke-and-hub model for stroke care may produce similar outcomes for patients presenting directly to spoke sites versus those presenting to the hub. In this study, arrival to hospital to groin puncture and reperfusion times are longer in spoke patients, however, the LKW to reperfusion times were similar. The data supports this model of care suggesting bypass of spoke sites for LVO AIS patients may not improve outcomes.