Outcome of patients with large vessel occlusion stroke after first admission in telestroke spoke versus comprehensive stroke center

Abstract

IntroductionWhile telestroke allows early intravenous thrombolysis (IVT) for ischemic strokes in spoke centers, mechanical thrombectomy (MT) for large vessel occlusion (LVO) is mainly performed at comprehensive stroke centers (CSCs). We aimed to compare 3 month outcome in patients with LVO after admission to a spoke center using telestroke compared with first CSC admission in our large regional stroke network, irrespective of final treatment decision.MethodsAll consecutive LVO patients who were admitted to one of six spoke centers or to the regional CSC within 6 hours of symptom onset were prospectively included from September 1, 2015 to August 31, 2017. All patients admitted to spoke centers were assessed on site with cerebral and vessel imaging. Primary outcome was 3 month favorable outcome (modified Rankin Scale score of 0–2).ResultsDistances between spoke centers and CSC ranged from 36 to 77 miles. Among 207 included patients, 132 (63.8%) were first admitted to CSCs and 75 (36.2%) to spoke centers. IVT was administered more in spoke centers (81.3% vs 53.8%, p<0.0001) while MT was performed less (26.7% vs 49.2%, p=0.001) and with a longer time from onset (303 vs 200 min, p<0.0001). No difference was found in 3 month favorable outcome between spoke centers compared with CSCs (32.0% and 35.1%, respectively; OR=0.68; 95% CI 0.42 to 1.10; p=0.12).ConclusionsDespite different distribution of reperfusion therapies for LVO patients managed by telemedicine, we could not demonstrate a difference in functional outcome according to admission location in a large area with long distances between centers.

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

“…Of the 12 studies [12][13][14][15]18,19,[30][31][32][39][40][41] that reported 90-day stroke mortality, the values were in similar ranges with 8 out of 13 studies demonstrating a non-significant higher mortality in TM care. 13,14,31,32,[39][40][41] Similarly, no statistical significance was found in mRS scores 90 days post-stroke between TM and NTM care.…”

“…Of the 12 studies [12][13][14][15]18,19,[30][31][32][39][40][41] that reported 90-day stroke mortality, the values were in similar ranges with 8 out of 13 studies demonstrating a non-significant higher mortality in TM care. 13,14,31,32,[39][40][41] Similarly, no statistical significance was found in mRS scores 90 days post-stroke between TM and NTM care. However, of the 17 studies [13][14][15][16]18,19,23,24,26,29,30,[32][33][34]39,40 that reported mRS scores 90 days post-stroke, patients using NTM care tended to have a non-significantly higher likelihood of scoring poor clinical outcomes, indicated by an mRS score of 3-6.…”

“…13,14,31,32,[39][40][41] Similarly, no statistical significance was found in mRS scores 90 days post-stroke between TM and NTM care. However, of the 17 studies [13][14][15][16]18,19,23,24,26,29,30,[32][33][34]39,40 that reported mRS scores 90 days post-stroke, patients using NTM care tended to have a non-significantly higher likelihood of scoring poor clinical outcomes, indicated by an mRS score of 3-6. Out of the 17 studies, 5 reported mRS scores of 0-1; 14,15,23,24,34 as such, poor functional independence could not be calculated for patients in these studies.…”

“…15,26,37 Considering the percentages of patients in both groups experienced sICH after their treatment, rates were comparatively close and typically fluctuated between a range of 0% and 10%. Two studies 21,32 reported a rate of sICH higher than 10% for both groups, while one study 21 reported a rate higher than 10% for the TM group only.…”

Risk factors of unexplained early neurological deterioration after treatment for ischemic stroke due to large vessel occlusion: a post hoc analysis of the HERMES study

“…In comparison with the mothership paradigm, transferred patients have been reported to be more likely to suffer worse clinical outcomes, due to the increased time to groin puncture and reperfusion 33 34. However, including ‘onset to randomization’ in our multivariable model, secondary transfer was not associated with UnEND.…”