Study Suggests Severe Hemiparesis May Be a Prehospital Tool to Triage Stroke Patients for Endovascular Treatment

August 18, 2015—Rishi Gupta, MD, et al conducted a pilot study to assess diagnostic accuracy and treatment times of stroke patients and found that severe hemiparesis could be used as a prehospital tool to triage stroke severity. The study was published online ahead of print in the Journal of NeuroInterventional Surgery (JNIS).

In JNIS, the investigators noted that with the recent publication of trials showing the benefits of mechanical thrombectomy, opportunities exist to refine prehospital processes to identify patients with larger stroke syndromes.

The study investigators, who are from Wellstar Health System in Marietta, Georgia, retrospectively reviewed consecutive patients with severe hemiparesis or hemiplegia who were brought via helicopter from rural parts of the region to their institution from December 1, 2014 to June 5, 2015. They assessed the accuracy of the diagnosis of stroke and the number of patients requiring endovascular therapy. Additionally, they reviewed the timeline along the path to treatment for patients who received endovascular therapy.

As summarized in JNIS, 27 of the 45 patients (60%) brought via helicopter from the field to Wellstar Health were diagnosed with an ischemic stroke. Twelve patients (26.7%) were treated with mechanical thrombectomy and six patients (13.3%) were treated with intravenous tissue plasminogen activator alone. An additional three patients required embolization procedures for a dural arteriovenous fistula or cerebral aneurysm. 

In total, 15 of 45 patients (33%) received an endovascular procedure, and 21 patients (46.7%) received an acute treatment. For patients treated with thrombectomy, the median time from first medical contact to groin puncture was 101 minutes, with eight of 12 patients (66.7%) discharged to home, reported the investigators.

The investigators concluded that severe hemiparesis or hemiplegia may be a reasonable prehospital tool in recognizing patients requiring endovascular treatment. They noted that earlier identification may lead to faster treatment and potentially better outcomes. Further prospective controlled studies are required to assess the impact of this methodology on outcomes and cost-effectiveness, advised the investigators in JNIS.

“We hope to use this pilot data to work with regional stroke networks to develop a prehospital tool to identify patients with larger stroke syndromes who may be best served by going directly to a center that can provide endovascular stroke treatments,” said Dr. Gupta in comments to Endovascular Today. “This will allow for faster treatment and better neurological recovery. The challenge will be identifying what threshold of sensitivity and specificity for a scale will be acceptable by regional stroke networks and account for the potential delays in the delivery of intravenous tPA. These questions will require studies to compare various scales and ascertain which ones have the highest yield but also can be employed effectively at the prehospital level by the providers.”