A Comparison of Two Stroke Cohorts Cared for by Two Different Specialties in a Practice-Based Tele-Stroke Population

Publication date: Available online 23 February 2018
Source:Clinical Neurology and Neurosurgery
Author(s): Elias Atallah, Kimon Bekelis, Hassan Saad, Nohra Chalouhi, Sophia Dang, Jonathan Li, Ayan Kumar, Justin Turpin, Randa Barsoom, Stavropoula Tjoumakaris, David Hasan, Maureen Deprince, Giuliana LabellaRN, Robert H. Rosenwasser, Pascal Jabbour
ObjectivesNeurologists have continually led the assessment and management of Acute Ischemic Stroke(AIS) by use of IV-rtPA, anti-platelet therapy, antihypertensives, and other pharmacologic agents. Since the advent of mechanical thrombectomy(MT) and its proven efficacy, neurovascular surgeons(NS) are playing an increasingly important role in the management and overall care of AIS. We assessed outcomes of AIS patients managed by NS, who have been traditionally managed by neurologists.Patients and MethodsOutcomes of AIS patients who presented to the telestroke system, over a 5-year period, were assessed. NIHSS and mRS stroke scales were used as outcome metrics. Multivariate analysis was conducted to compare outcomes of patients treated by neurovascular surgeons and those treated by neurologists.Results1,353 AIS patients were identified. 21.6% received care from neurosurgeons and 78.4% received care from neurologists. Of the neurologist-managed group: 7.8% received MT and were followed by NS, 34% received IVrt-PA, average discharge NIHSS = 9.0 (SD = 8.42), latest follow-up mRS < 2 = 57.5% and mortality rate = 9.4%. Of the neurovascular surgeon-managed group: 7.4% patients received MT, 20% received IVrt-PA, average discharge NIHSS = 0.14(SD = 0.72), latest follow-up mRS ≤2 = 98.6% and mortality rate = 8.3%. There were no significant differences between groups in MT use (OR 1.22; CI95%, 0.971–2.09; p = 0.464), IVrt-PA administration (OR 0.98; CI95%, 0.70–1.38; p = 0.924), mortality rate (OR 1.21; 0.71–2.03; p = 0.483) and patients' latest mRS, p = 0.873.ConclusionsAIS requires multidisciplinary management. Care provided by neurosurgeons has similar efficacy and patient outcomes as the care provided by neurologists. These findings support the role and ability of neurosurgeons to manage and care for these patients.



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