Safety and efficacy of thrombolysis in telestroke

Kepplinger, Jessica; Barlinn, Kristian; Deckert, Stefanie; Scheibe, Madlen; Bodechtel, Ulf; Schmitt, Jochen

doi:10.1212/wnl.0000000000003148

Cited by 118 publications

(84 citation statements)

References 33 publications

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“…Telestroke has brought IVT and stroke neurologist's expert consultation closer to the patients. Safety and efficacy of fibrinolysis delivered through telestroke networks in the 3-h window has been demonstrated in a recent meta-analysis including 7 studies [3]. However, due to the high beneficial effect of early endovascular treatment in patients with large vessel occlusion [4], a debate exists on whether transferring selected acute stroke patients directly from the field to the closest center with endovascular treatment capabilities determines a better prognosis than transferring them to a local center able to administer IVT [5].…”

Section: Introductionmentioning

confidence: 98%

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers

et al. 2018

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Objectives: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study. Methods: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC). After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry. Results: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages. Conclusions: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.

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Section: Introductionmentioning

confidence: 98%

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers

et al. 2018

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“…Using a camera and having access to brain computed tomography (CT), neurologists at remote sites were able to determine whether a patient would be candidate for reperfusion treatment with intravenous thrombolysis. It was subsequently shown that telestroke achieved similar safety and outcome results to those in comprehensive stroke centers . Importantly, however, acute stroke treatment has changed dramatically over the last few years, endovascular thrombectomy (EVT) is now the standard of care in large vessel occlusion (LVO) strokes.…”

Section: Introductionmentioning

confidence: 99%

“…It was subsequently shown that telestroke achieved similar safety and outcome results to those in comprehensive stroke centers. [2][3][4] Importantly, however, acute stroke treatment has changed dramatically over the last few years, endovascular thrombectomy (EVT) is now the standard of care in large vessel occlusion (LVO) strokes.…”

Section: Introductionmentioning

confidence: 99%

Implementation of multimodal computed tomography in a telestroke network: Five‐year experience

O’Brien

Evans

2019

CNS Neurosci Ther

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Aims Penumbral selection is best‐evidence practice for thrombectomy in the 6‐24 hour window. Moreover, it helps to identify the best responders to thrombolysis. Multimodal computed tomography (mCT) at the primary centre—including noncontrast CT, CT perfusion, and CT angiography—may enhance reperfusion therapy decision‐making. We developed a network with five spoke primary stroke sites and assessed safety, feasibility, and influence of mCT in rural hospitals on decision‐making for thrombolysis. Methods Consecutive patients assessed via telemedicine from April 2013 to June 2018. Clinical outcomes were measured, and decision‐making compared using theoretical models for reperfusion therapy applied without mCT guidance. Symptomatic intracranial hemorrhage (sICH) was assessed according to Safe Implementation of Treatments in Stroke Thrombolysis Registry criteria. Results A total of 334 patients were assessed, 240 received mCT, 58 were thrombolysed (24.2%). The mean age of thrombolysed patients was 70 years, median baseline National Institutes of Health Stroke Scale was 10 (IQR 7‐18) and 23 (39.7%) had a large vessel occlusion. 1.7% had sICH and 3.5% parenchymal hematoma. Three months poststroke, 55% were independent, compared with 70% in the non‐thrombolysed group. Conclusion Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH.

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“…76 In another study on a large telestroke cohort in the Delaware valley, the differences between patients transferred and non-transferred to a primary stroke care center ter. 79 The strategy consisting in the initiation of thrombolytic treatment in a spoke hospital under the guidance provided by a specialist located in a central hospital using telemedicine facilities, followed by the transfer of patient to the central hospital, has been named the "drip and ship" strategy and proved to provide outcomes comparable to those obtained using treatment directly in the central hospital. 80 In addition, a study by Heffner et al…”

Section: Telestroke Networkmentioning

confidence: 99%

Review. Regional Networks in Acute Cardiac Care

Marton-Popovici

2017

Journal of Cardiovascular Emergencies

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STEMI nETworkSThe implementation of dedicated networks for urgent revascularization in patients with ST-elevation myocardial infarction (STEMI) have been proved to represent a lifesaving strategy and is currently the goal of many healthcare systems. 6-10In patients with acute myocardial infarction, survival depends largely on the amount of viable myocardium remaining after the infarction. 11-13 The recovery of myocardial tissue is the main goal of therapy in emergency settings and can be achieved by urgent revascularization. 14-16In order to be effective, reperfusion of an occluded coronary artery should be achieved in the first 12 hours after the onset of chest pain. 17 While many precious hours are lost by the patients who do not present in time to the specialized services, sustained organizational efforts have been made in order to shorten the time from presentation to revascularization. 18-22One of the first regional STEMI networks has been initiated in the USA in Minnesota, including referral hospitals located at a radius of 210 miles from the pPCI center.The geographic territory surrounding the pPCI center was

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Safety and efficacy of thrombolysis in telestroke

Abstract: URL: http://www.crd.york.ac.uk/PROSPERO. Unique identifier: CRD42015017232.

Cited by 118 publications

References 33 publications

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers

Implementation of multimodal computed tomography in a telestroke network: Five‐year experience

Review. Regional Networks in Acute Cardiac Care

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