Abstract A140: Effect of Vessel Occlusion Location and NIH Stroke Scale on Endovascular Thrombectomy Eligible Door-In-Door-Out Time

Introduction: Door-in-door-out (DIDO) time may impact outcomes in ischemic stroke patients with large vessel occlusions (LVO). The effect of LVO location and clinical presentation on DIDO has not been greatly studied. We examined how the severity of neurological deficit and location of the LVO affected DIDO. We hypothesized that proximal anterior circulation LVO (M1, ICA) and worse neurological deficit would lead to shorter DIDO. Methods: Data were retrospectively collected from 14 primary stroke centers in southern California who were transferred for endovascular therapy from <a href="tel:01/2021-12">01/2021-12</a>/2023. Median (IQR) DIDO was calculated for patients with proximal anterior LVO (M1, ICA) and for those with other vessel occlusions (OVO) defined as ACA, M2, M3, PCA, or Basilar. Ordinary least square regression was used for DIDO regression models to assess the effect of NIHSS and age. Chi-square test and t-test were used for other statistical analyses. Results: A total of 331 patients were identified with a vessel occlusion, 168 (51%) patients with either M1 or ICA occlusions and 163 (49%) with other occlusions. 50.9% were female and 69.3% were ≥ 65 years. The overall median NIHSS was 13.5 (IQR 7-20) and median DIDO was 93 minutes (IQR 72-127 minutes). More patients in the OVO group had CHF (23.9% vs 11.9%, p = 0.007) and hypertension (68.1% vs 54.8%, p = 0.017). There was a trend toward quicker DIDO for ICA and M1 occlusions (88.5{IQR 66.8-123 minutes}) vs. OVO (95{IQR 78.5-131 minutes}) (p = 0.065). In regression analysis, one unit increase in NIHSS was associated with 0.93 (CI 1.68-0.19) (p = 0.014) -minute decrease in DIDO. NIHSS ≥ 6 was associated with lower DIDO by 35.14 minutes (CI 18.64-51.64) (p<0.001) (Fig. 1). In addition, one year increase in patient age was associated with 0.45 (CI 0.07-0.84) (p =0.021) minute decrease in DIDO (Fig 2.). Conclusions: Higher NIHSS and older age were associated with faster DIDO. Patients with proximal anterior circulation LVO (ICA and M1) had a trend toward faster DIDO. A single point increase in the NIHSS was significantly associated with nearly a minute decrease in DIDO. DIDO was faster by nearly half a minute per one year increase in age. Increased age was associated with nearly half a minute decrease in DIDO per year.