Abstract Details

Presenting syndromes may impact time to AIS recognition and treatment, but impact on time to treatment in LVO patients is not well known.

We compared differences in time to presentation, initial imaging, and revascularization in left (LHS) and right (RHS) hemisphere large vessel occlusion (LVO) acute ischemic stroke (AIS) patients.

A retrospective review of hospitalized adults with LVO at our Comprehensive Stroke Center from 2017-2018 was performed. Time differences between LHS and RHS cohorts were compared with negative binomial regression, with ratios conveying proportional time difference between cohorts. We adjusted for demographics, NIH Stroke Scale, and comorbidities. Unadjusted subgroup analysis of patients presenting with aphasia or neglect and no motor deficit was performed.

There were 111 LHS and 98 RHS patients (53% and 44% female; median age 73 and 70, respectively). 58.6% (n=65) of LHS and 52.0% (n=51) of RHS patients received endovascular therapy (ET). 8.1% (n=9) of LHS and 11.2% (n=11) of RHS patients received tissue plasminogen activator (t-PA). Median time from last known well to presentation (291 vs. 316.5 minutes) and arrival to CT imaging (8 minutes in both cohorts), t-PA (51 vs. 50 minutes), and ET (98 vs. 81 minutes) did not statistically differ between LHS and RHS. In both cohorts, older age was associated with increased time to ET (LHS: RR=1.02, 95% CI 1.00-1.03, p=0.028; RHS: RR=1.01, 95% CI 1.00-1.03, p=0.02). Patients presenting with aphasia or neglect without a motor deficit had longer time to ET (LHS: RR=2.52, 95% CI 1.39-4.58, p=0.002; RHS: RR=1.94, 95% CI 1.34-2.80, p=0.0004) compared to all others in their respective hemispheric cohort.

There were no overall differences between right and left hemisphere strokes. However, aphasia or neglect without motor weakness, as well as older age, were associated with longer time to revascularization, possibly reflecting delays due to risk-benefit debate amongst providers.