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  • Should Neurosurgeons Prescribe IntraVenous-tissue Plasminogen Activator?

    Final Number:

    Elias Atallah MD; Kimon Bekelis MD; Jackson Walker BA; Nohra Chalouhi MD; Stavropoula I. Tjoumakaris MD; Robert H. Rosenwasser MD, FACS, FAHA; Pascal Jabbour MD

    Study Design:

    Subject Category:
    Ischemic Stroke

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: Acute ischemic stroke patients have been mostly cared by Neurointensivists(NI). Prescription rates of Intra Venous-tissue Plasminogen Activator (IV-tPA) have been increasing amongst emerging dually trained Neurovascular Surgeons(NS). We report the incidence of IV-tPA prescription between NS versus NI and the subsequent rates of clinically measurable hemorrhagic complication

    Methods: Of 5662 patients consulting for acute ischemic stroke symptoms, the medical charts of 855 patients who were recommended IV-tPA, were consecutively reviewed between 2013 and 2016. IV-tPA was dispensed by the on-call physician in our specialized stroke unit. multivariable logistic regression was conducted to control for confounding

    Results: From the 855 patients who were recommended IV-tPA, 365(43%) (Average Age=66yo, SD=16) received it, and constituted our study population. 48% were females. 78(21.3%) patients were cared by NS and 287(78.3%) patients were cared by NI. In the first group, the average symptom to needle time(STN) was 65min(SD=5min). 6/78(7.6%) patients received mechanical thrombectomy, only 6(7.6%) patients had a clinically significant hemorrhagic conversion following IV-tPA administration. No subsequent mortality was noted. In the Second group, the average STN time was 103min(SD=10min), 11/287(3.8%) patients received mechanical thrombectomy and only 11/287(3.8%) developed major hemorrhagic complications. 5/11 patients were announced dead. In multivariable logistic regression, physician specialty was not a predictor of hemorrhagic conversion or bad long-term clinical outcome: the average modified Rankin Scale was 0.4(SD=0.5) in the group cared by NS and 0.6(SD=1.0) in the second group cared by NI.

    Conclusions: Dually trained Neurovascular surgeons and Neurointensivists provide a comparable standard treatment of care for patients with acute ischemic stroke symptoms presenting to a specialized stroke unit.

    Patient Care: NS and NI work as a team in stroke centers. No one has evaluated the efficiency of NS compared to NI in a Specialized Stroke unit before. This study evaluates the treatment of care provided by NS and NI. It verifies the capability of Neurosurgeons to replace Neuro-intensivists and take charge of their patients' medical care whenever needed.

    Learning Objectives: Hybrid Neurovascular Surgeons provide a high treatement care for Acute Ischemic Stroke patient


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