CTA Protocols in a Telestroke Network Improve Efficiency for Both Spoke and Hub Hospitals

Abstract

BACKGROUND AND PURPOSE: Telestroke networks support screening for patients with emergent large-vessel occlusions who are eligible for endovascular thrombectomy. Ideal triage processes within telestroke networks remain uncertain. We characterize the impact of implementing a routine spoke hospital CTA protocol in our integrated telestroke network on transfer and thrombectomy patterns. MATERIALS AND METHODS:A protocol-driven CTA process was introduced at 22 spoke hospitals in November 2017. We retrospectively identified prospectively collected patients who presented to a spoke hospital with National Institutes of Health Stroke Scale scores $6

Symmetric CTA Collaterals Identify Patients with Slow-progressing Stroke Likely to Benefit from Late Thrombectomy

“…This has implications, especially in patients who first present to a hospital that does not have EVT capabilities and who require transfer for treatment (28). However, these markers require MRI or CT perfusion, which are not readily available at many centers (5,29). Furthermore, recent data have suggested extended window EVT is beneficial even without advanced imaging (30).…”

Presentation collateral patterns and outcomes after endovascular thrombectomy for large vessel occlusion stroke

“…33,34 At many smaller hospitals, MRI or CTP are not readily available. 6,35 There are several limitations to consider. First, patients were identified, and collateral patterns were evaluated retrospectively.…”

“…5 Unfortunately, community hospitals and underserved regions are often without these resources. 6,7 This is especially true for patients in the extended window or with unknown onset. 8 Furthermore, the transfer of patients to thrombectomy capable centers can be delayed, which reduces the likelihood of EVT.…”

Connecting Telestroke With Transfers

“…For example, in a study of protocol-driven CT angiographies at spoke hospitals, the receiving stroke center (hub hospital) thrombectomy rates for transferred patients increased twofold without a significant change in the total number of transfers. 9 More research is needed to better understand the characteristics, interventions, and clinical outcomes of transferred as well as nontransferred patients. The benefits of dedicated stroke center care go beyond thrombolysis and thrombectomy.…”