Is telestroke more effective than conventional treatment for acute ischemic stroke? A systematic review and meta-analysis of patient outcomes and thrombolysis rates

Abstract

Background: Telestroke systems operate through remote communication, providing distant stroke evaluation through expert healthcare providers. The aim of this study was to assess whether the implementation of a telestroke system influenced stroke treatment outcomes in acute ischemic stroke (AIS) patients compared to conventional in-person treatment. Aims: The study group evaluated multiple studies from electronic databases, comparing telemedicine (TM) and non-telemedicine (NTM) AIS patients between 1999 and 2022. aimed to evaluate baseline characteristics, critical treatment times, and clinical outcomes. Summary of review: A total of 12,540 AIS patients were included in our study with 7,936 (63.9%) thrombolyzed patients. Of the thrombolyzed patients, 4,150 (51.7%) were treated with TM while 3,873 (48.3%) were not. Mean age of TM and NTM cohorts were 70.45±4.68 and 70.42±4.63, respectively (p > 0.05). Mean NIHSS scores were comparable, with the TM group reporting a non-significantly higher mean (11.89±3.29.6 vs. 11.13±3.65, p>0.05). No significant difference in outcomes was found for symptoms onset-to- intravenous tissue plasminogen activator times (ivtPA) (144.09±18.87 vs. 147.18±25.97, p=0.632) and door-to-needle times (73.03±20.04 vs. 65.91±25.96, p=0.321). Modified Rankin scale scores (0-2) were evaluated and no significant difference was detected between cohorts (Odds Ratio (OR):1.06, 95% Confidence Interval (CI): 0.89-1.29, p=0.500). Outcomes did not indicate any significance between both cohorts for 90-day mortality (OR: 1.16, 95% CI: 0.94-1.43, p=0.17) or symptomatic intracranial hemorrhage (sICH) (OR: 0.99, 95% CI: 0.73-1.34, p=0.93). Results between groups were also non-significant when analyzing the rate of thrombolysis with ivtPA (30.86%±30.7 vs. 20.5%±18.6, p=0.372) and endovascular mechanical thrombectomy (11.8%±11.7 vs. 18.7%±18.9, p=0.508). Conclusion: Use of telestroke in the treatment of AIS patients is safe with minimal non-significant differences in long-term outcomes and rates of thrombolysis compared to face-to-face treatment. Further studies comparing the different methods of TM are needed to assess the efficacy of TM in stroke treatment.

Reperfusion therapy for stroke: From improving global access, to thrombectomy beyond 24 hours

“…12 One strategy for improving access to thrombolysis, particularly in rural regions, is telemedicine, although there has been concern that it could have less good outcomes than face-to-face evaluation. Reassuring data are provided in this issue of IJS by Mohamed et al 13 They performed a systematic review of published evaluations of telemedicine for stroke thrombolysis, and included data on 12,540 acute ischemic stroke patients of whom 7936 (63.9%) were thrombolysed; of these, 4150 (51.7%) were treated with telemedicine, while 3873 (48.3%) were not. There was no significant difference in symptom onset to thrombolysis time, outcome as assessed by the modified Rankin score, or mortality.…”

Teleneurology and Artificial Intelligence in Clinical Practice

“…A recent report by the Telemedicine Work Group of the American Academy of Neurology (AAN) 13 and publications sharing COVID-19 pandemic-specific applications examined outcomes in a variety of neurology subspecialty settings 14 . Teleneurology for acute stroke care has been extensively studied for safety and efficacy and is well documented to be similar to, and in some cases superior to, traditional stroke care models 13,15-17 . The question remains whether other neurologic disorders are equally amenable to remote care and, if so, what factors need to be considered to provide this care with the same quality as traditional care paradigms.…”

Satisfaction of adult and pediatric neurologists and neurosurgeons using telehealth during the COVID-19 pandemic in Saudi Arabia: a cross-sectional study

“…TeleStroke has advanced beyond mobile computed tomography (CT)-enabled ambulances to provide hospital-level care directly to patients ( 6 ). Furthermore, TeleStroke appears to be safe and cost-effective when compared with usual care ( 7 , 8 ). With improved education, the capacity of local hospitals worldwide to manage acute stroke cases has been enhanced ( 2 ).…”