22. European Stroke Conference 650 Acute stroke: clinical patterns and practice Wake-up Stroke in a Singapore Tertiary Hospital and the Potential Future Indications for Reperfusion Therapies M.S.H Tan1, A.P. Ramaswami2, E.S.L. Ang3, S.S. Ho4, S.C. Ng5, F.P. Woon6, D.A. De Silva7 Duke-NUS Graduate Medical School, Singapore, SINGAPORE1, Singapore General Hospital, Singapore, SINGAPORE2, National Neuroscience Institute, Singapore, SINGAPORE3, National Neuroscience Institute, Singapore, SINGAPORE4, Singapore General Hospital, Singapore, 5, Singa-pore General Hospital, Singapore, SINGAPORE6, National Neuroscience Institute, Singapore, SIN-GAPORE7 Background: Most stroke patients who wake up with symptoms are not eligible for acute reperfu-sion treatments such as intravenous thrombolysis. There are no published data on wake-up stroke in Singapore. We studied the prevalence of wake-up stroke patients in Singapore and compared their profile to known stroke onset patients to identify the potential future indications for thrombolytic treatment. Methods: This is a prospective observational study of consecutive ischemic stroke pa-tients presenting to a single tertiary hospital in Singapore over 3 years from 2010. Results: Among the 2257 ischemic stroke patients studied, 30% (683) were wake-up strokes median age 67 years (IQR 57-76) and 86% < 80 years old. The median NIHSS score was 4 (IQR 2-8), with 97% hav-ing a score of <20. The Oxfordshire Community Stroke Project distribution was 69% lacunar, 14% partial anterior circulation, 10% posterior circulation, and 6% total anterior circulation infarction (TACI). Patients with wake-up stroke presented to hospital at a median duration of 17 hours (IQR 10-45 hours) from time of last seen well, with 20% within 9 hours. Compared to known onset pa-tients, a higher of proportion of wake-up stroke patients presented beyond 3.5 hours (95 vs 73%; p<0.001), and had stroke severity of NIHSS ≥5 (50% vs 41%; p<0.001). Conclusion: The preva-lence of wake-up stroke at 30% in our study is consistent with published literature. Nearly 1/3 of our ischemic stroke patients could be considered for ongoing trials studying wake-up strokes such as those employing imaging surrogates for duration from stroke onset. In addition, 1/5 of wake-up stroke patients would potentially be eligible for reperfusion treatments should thrombolytic time window be extended to 9 hours. The low proportion of wake-up stroke patients with relative contra-indications to thrombolysis, namely severe neurological deficits, TACI, and old age makes potential future indications for reperfusion treatments promising. 690 © 2013 S. Karger AG, Basel Scientific Programme 651 Acute stroke: clinical patterns and practice How often can door to needle time of less than 60 minutes be accomplished in a State-wide Te-lestroke network? S. Chaturvedi1, P. Bhattacharya2, K. Rajamani3, R. Madhavan4, G. Norris5, C. Parliament6 Wayne State University, Detroit, USA1, Wayne State University, Detroit, USA2, Wayne State Uni-versity, Detroit, USA3, Wayne State University, Detroit, USA4, Wayne State University, Detroit, USA5, St. Joseph Hospital, Pontiac, USA6 Background: Telestroke for acute stroke care is recommended in hospitals without bedside neuro-logical expertise, to increase the utilization of intravenous tPA. The benefits from tPA are maximum if administered within 60 minutes of a patient’s arrival at the emergency room. Stroke systems are geared towards providing organized and efficient stroke care to patients to achieve this target. Our objective is to determine if door to needle times <60 minutes can be achieved in member hospitals of a statewide telemedicine network. Methods: The Michigan Stroke Network is a telestroke system that provides acute stroke expertise across 32 hospitals within the state of Michigan (USA). About one-fifth of member hospitals have primary stroke center certification. Patients receiving tPA following a two way audio-video consul-tation are followed concurrently and data regarding time of symptom onset, time of arrival, time of pager activation, time of telemedicine consultation and time of tPA administration are gathered for quality improvement. Proportion of patients receiving tPA after a telestroke consultation, within 60 minutes of arrival at the member hospitals was reviewed. Results: Over 8 months (Jan 2012 through August 2012) 36 patients at member hospitals received intravenous tPA after a video consultation. Half (50%) of the consultations achieved a door to needle time < 60 minutes. This is notably higher than the nationwide proportion of 29% among Get With the Guideline hospitals. The fastest case in the present dataset received tPA within 28 minutes of ar-rival. Early activation of the network pager by emergency physicians, along with not using advanced imaging, at the member hospitals helped reduce door to needle times. Conclusion: Door to needle times less than 60 minutes can be achieved using a telestroke model. Telemedicine not only improves tPA utilization, but can also be used to administer tPA more effi-ciently and effectively. Further data collection on network patients is ongoing and will be presented.
Karger_ESC London_2013
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