Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window

Abstract

Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network.Methods: Observational study of patients with AIS who received IVT at the Stroke Eastern Saxony Telemedical Network between 01/2014 and 12/2015. We compared safety data including symptomatic intracerebral hemorrhage (sICH; according to European Cooperative Acute Stroke Study II definition) and any intracerebral hemorrhage (ICH) between patients admitted to telestroke spoke sites and patients directly admitted to a tertiary stroke center representing the hub of the network. We also assessed short-term efficacy data including favorable functional outcome (i.e., modified Rankin Scale ≤ 2) and National Institutes of Health Stroke Scale (NIHSS) at discharge, hospital discharge disposition, and in-hospital mortality.Results: In total, 152 patients with AIS were treated with IVT in the expanded time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]. Patients treated at spoke sites had less frequently a large vessel occlusion [8/104 (7.7) vs. 20/48 (41.7%); p < 0.0001], a determined stroke etiology (p < 0.0001) and had slightly shorter onset-to-treatment times [210 (45) vs. 228 (58) min; p = 0.02] than patients who presented to the hub site. Both cohorts did not display any further differences in demographics, vascular risk factors, median baseline NIHSS scores, or median baseline Alberta stroke program early CT score (p > 0.05). There was no difference in the frequency of sICH (4.9 vs. 6.3%; p = 0.71) or any ICH (8.7 vs. 16.7%; p = 0.15). Neither there was a difference regarding favorable functional outcome (44.1 vs. 39.6%; p = 0.6) nor median NIHSS [3 (5.5) vs. 2.5 (5.75); p = 0.92] at discharge, hospital discharge disposition (p = 0.28), or in-hospital mortality (9.6 vs. 8.3%; p = 1.0). Multivariable modeling did not reveal an association between telestroke and sICH or favorable functional outcome (p > 0.05).Conclusions: Delivery of IVT in the expanded 3- to 4.5-h time window through a telestroke network appears to be safe with equivalent short-term functional outcomes for spoke-and-hub center admissions.

Application of Integrated Emergency Care Model Based on Failure Modes and Effects Analysis in Patients With Ischemic Stroke

“…In the results of this study, there was no significant difference between the intervention group and the control group in the symptomatic intracerebral hemorrhage incidence and mortality rate. This may be because, even if intravenous thrombolysis is completed within the time window, 6% of patients with AIS are still at risk of symptomatic intracerebral hemorrhage after treatment ( 21 ). This further suggests that after the optimization of the emergency procedure in this study, although the overall treatment rate of patients was effectively improved, it was still much lower than that in developed countries such as the United States, and the safety and efficacy of patients receiving thrombolytic therapy still need to be improved.…”

Optimizing Time Management for Drip-and-Ship Stroke Patients Qualifying for Endovascular Therapy—A Single-Network Study

“…All hospitals in the network provided stroke imaging 24/7. A stroke fellow of the CSC supported the affiliated CHs via stroke telemedicine (telestroke) system [ 9 ].…”

NanoSHP099‐Targeted SHP2 Inhibition Boosts Ly6Clow Monocytes/Macrophages Differentiation to Accelerate Thrombolysis

“…[ 1 ] Among these VTE cases, tumor‐associated thrombus (TAT) accounts for nearly 20% of cases and has become the second leading cause of death in tumor patients. [ 2 , 3 ] Nonetheless, common thrombolytic drugs are limited by narrow therapeutic windows, [ 4 , 5 ] unsatisfactory effects, nonspecific bleeding, [ 6 , 7 ] and thrombocytopenia. [ 8 ] Therefore, it is of great significance to develop new strategies that promote thrombolysis effectively and safely.…”