Abstract WP336: Telestroke To Bring Tertiary Center Acute Stroke Practice To Rural Minnesota Residents; Percent Treated With Interventional Procedures, Timing, And Clinical Results.

Abstract

The utility of telemedicine to increase the use of IV tPA for acute ischemic stroke (AIS) patients in the rural setting is well established. The availability of intraarterial (IA) reperfusion therapy is restricted to larger stroke centers in metropolitan areas so the process for evaluation and transfer within a stroke system of care will be critical to its rapid delivery to rural patients. In 2012, we conducted a review of the use of IA therapy in our stroke system; studying efficiency of the team approach, timing of treatment, and patient outcomes to evaluate the hypothesis that telemedicine can facilitate IA treatment for the AIS patient presenting in a rural setting. METHODS: All patients presenting to the spoke hospitals (SHs) and the hub hospitals (HH) with AIS and subsequently receiving IA therapy were reviewed for the months of March 2011 through February 2012. This review followed institution of a stroke code improvement process for SHs which included an aggressive 30 minute door-to-drug goal, addition of CTA imaging, and early mobilization of helicopter transport. FINDINGS: Of the HH patients receiving reperfusion therapy 26 of 68 patients (38%) received IA treatment and 62% received IV tPA treatment alone. In contrast, only 5 of 31 treated cases from SHs (16%) received IA treatment. In IA treated cases, mean door-to-case-start time from the SHs (143 min) was comparable to that of cases presenting directly to the HH (117 min) despite the helicopter travel required prior to case start for SHs. Reperfusion success (TICI2b/3) was similar whether the patients presented to HH or the SHs (69% and 60%) and discharge MRS≥3 was achieved in 46% and 40% respectively. CONCLUSION: With a telemedicine supported system, IA treatment options can be initiated in a time efficient fashion with similar outcomes whether the patient presents to a rural spoke hospital site or the hub hospital with IA capability. Differences in the rate of use of IA treatment may be related to EMS referral patterns of patients with severe stroke to a tertiary stroke center.