<h3>Objective:</h3> This study aims to assess the impact of CTP acquisition in regional hospitals on quality metrics, functional and safety outcomes in patients with LVO. <h3>Background:</h3> The utility of CTP imaging in spoke hospitals to determine eligibility for MT remains controversial. <h3>Design/Methods:</h3> Consecutive adult patients treated for LVO after initially presenting to regional spokes between Jan 2021 to Dec 2021 were included. CTP was added to acute stroke imaging protocol in April 2021. Demographics, NIHSS, quality metrics, imaging parameters, and functional outcomes were compared between patients who did vs. did not undergo CTP at a regional hospital. Core volume growth and rate (ml/min) was assessed for patients with CTP data both at the regional and at the CSC. <h3>Results:</h3> CTP studies were performed on 1083 in regional patients and LVO was confirmed in 29 (2.6%) patients. Of these, 14 were transferred to CSC without CTP at the regional and 15 were transferred with CTP at regional hospital. Age (p=0.44), NIHSS (p=0.08), door to thrombolysis (p=0.13), door-in-door-out (p=0.17) times, successful reperfusion (TICI IIb/III; p=0.83) and hemorrhagic transformation (ECASS III; p=0.49) did not differ significantly between the groups. Rates of mRS 0–2 were similar in both groups (p=0.85). In subgroup analysis of patients who underwent CTP both at the regional facility and CSC (n=15), median core volume grew significantly but slowly (0[0, 7] ml vs. 7 [0, 14] ml, p=0.022), at a median rate of 0 [0, 0.07] ml/min. No patients were excluded from thrombectomy due to core growth. <h3>Conclusions:</h3> Our study suggests that regional site perfusion imaging does not have a significant impact on process times, quality metrics and outcomes. Core volume grows during interfacility transfers without an impact on eligibility for MT. A larger study is needed to assess the role perfusion imaging in regional spokes. <b>Disclosure:</b> Miss Abarca has nothing to disclose. Dr. Potluri has nothing to disclose. Dr. Miller has nothing to disclose. Mrs. Stowe has nothing to disclose. Dr. Wideman has nothing to disclose. Dr. Tsai has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Tricia Tubergen has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Todd Mulderink has nothing to disclose. Dr. Min has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbott . Dr. Min has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic . Dr. Wees has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Ahrar has nothing to disclose. Justin Singer has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Stryker. Justin Singer has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Justin Singer has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Ceronovus. Justin Singer has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Nico. The institution of Justin Singer has received research support from Stryker Grant. Paul Mazaris has nothing to disclose. John Oostema has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Life EMS. The institution of John Oostema has received research support from Spectrum Health. John Oostema has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with MDHHS. The institution of Dr. Khan has received research support from NINDS. The institution of Dr. Khan has received research support from Genentech. The institution of Dr. Khan has received research support from Spectrum Health-MSU alliance. Dr. Khan has received research support from NIH. 

System-wide implementation of Computed Tomography Perfusion (CTP) Imaging for Acute Stroke: Impact on Quality, Safety and Outcomes (P7-5.009)


 Background:
 Mechanical thrombectomy (MT) is effective for reducing morbidity in patients presenting within 24 hours of symptom onset with large vessel occlusion (LVO). Perfusion imaging is helpful in selecting patients in this extended time window. We report our experience of implementing CTP imaging in all our spokes and its impact on quality metrics and outcomes.
 
 
 Methods:
 Acute Stroke Imaging Protocol was updated to include CTP in addition to CT and CTA for all suspected stroke patients presenting within 24 hours of symptoms in April 2021 processed by RAPID AI (iSchema View inc, Menlo Park, CA, USA). Consecutive patients aged ≥18 years with suspected stroke presenting to regional spokes between Jan 2021 to Dec 2021 were included in the analysis. Demographics, NIHSS, quality metrics at regional facility (Door-to-thrombolysis, door-in-door-out times) and Comprehensive Stroke Center-CSC (door-to-arterial access, reperfusion rates (TICI IIb/III), hemorrhagic transformation) and functional outcomes (modified Rankin Scale, mRS) at 90 days were compared between the groups.
 
 
 Results:
 CTP studies were performed on 1113 patients between April 2021 and December 2021. RAPID AI processing identified LVO in 203 (18.7%) patients, of which 29 (14%) patients were included in this analysis; 14 patients were transferred to CSC for possible MT without CTP at regional facility and 15 were transferred with CTP at regional. Age (p=0.44), NIHSS (p=0.08) and onset-arrival time (p=0.54) were similar in both groups at the regional facility. Door to thrombolysis (p=0.13) and door-in-door-out (p=0.17) times were similar in both groups at the regional facility. CSC metrics of door-to-arterial access times (p=0.84), reperfusion (TICI IIB/III) (p=0.83) and hemorrhagic transformation (p=0.49) rates were similar between groups. 90 day good functional outcomes (mRS 0-2) were similar in patients undergoing thrombectomy (p=0.86).
 
 
 Conclusion:
 Our study suggests that AI supported perfusion imaging is feasible in a large stroke network and does not appear to have a significant impact on process times, quality metrics and outcomes. A larger study would need to be conducted to validate the observed results.


Abstract TP26: System-wide Implementation Of Computed Tomography Perfusion (CTP) Imaging


 Background:
 Perfusion imaging is used to determine eligibility for mechanical thrombectomy (MT) in patients presenting with large vessel occlusion (LVO) in acute ischemic stroke. The utility of CT perfusion (CTP) imaging in spoke hospitals remains controversial. The aim of the study was to compare the imaging parameters, functional and safety outcomes in patients selected for MT based on CTP availability in regional hospitals.
 
 
 Methods:
 Consecutive adult patients treated for LVO after initially presenting to regional spokes between Jan 2021 to Dec 2021 were included in the analysis. Our standard Acute Stroke Imaging Protocol included CT/CT angiogram. CT perfusion was added to the protocol in April 2021. Demographics, NIHSS, imaging metrics (ASPECTS, CTA collateral score, reperfusion (mTICI 2b/3) rates), hemorrhage (per ECASS III) and functional outcomes (modified Rankin Scale of 0-2 at 90 days) were compared between patients who did vs. did not undergo CTP at regional. Core infarct volume growth and rate (ml/min) was assessed for patients with CTP data both at the regional and at the Comprehensive Stroke Center (CSC).
 
 
 Results:
 A total of 29 patients met inclusion during the study period. Of these, 14 patients were transferred to CSC for possible MT without CTP at the regional facility and 15 were transferred with CTP at regional. Age (p=0.44), NIHSS (p=0.08) and onset-to-regional facility arrival time (p=0.54) were similar in both groups. For all patients, repeat imaging at the CSC showed significantly decreased ASPECTS (p=0.002) but stable CTA collateral score (p=0.94). For patients who underwent CTP both at the regional facility and CSC, median core infarct volume grew significantly (0[0, 7] ml vs. 7 [0, 14] ml, p=0.022), with a median growth rate of 0 [0, 0.07] ml/min. No patients were excluded from thrombectomy due to core infarct growth. Rates of successful reperfusion (p=0.83) and hemorrhagic transformation (p=0.49) did not differ significantly between the groups. Rates of mRS 0-2 were similar in both groups (p=0.85).
 
 
 Conclusion:
 Our study suggests that core infarct grows during interfacility transfers without an impact on selection for thrombectomy and outcomes. A larger study is needed to assess the need for repeating perfusion imaging at CSC.


Abstract TMP95: Infarct Growth During Inter-facility Transfer In An Integrated Stroke Network

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System-wide implementation of Computed Tomography Perfusion (CTP) Imaging for Acute Stroke: Impact on Quality, Safety and Outcomes (P7-5.009)

Abstract TP26: System-wide Implementation Of Computed Tomography Perfusion (CTP) Imaging

Abstract TMP95: Infarct Growth During Inter-facility Transfer In An Integrated Stroke Network