Impacts of telestroke implementation on use of intravenous thrombolysis and short-term outcomes in patients with acute ischemic stroke in a remote area

Abstract

Objective To investigate the impacts of telestroke on use of intravenous thrombolysis and short-term outcomes in patients with acute ischemic stroke in a remote area. Methods Since March 2017, the Advanced Stroke Center of the Ninth People's Hospital, Shanghai Jiaotong University School of Medicine has used telestroke to guide intravenous thrombolysis for primary stroke center of Xiangyun County People's Hospital in Dali, Yunnan. The rate of intravenous thrombolysis, door to needle (DTN) time, and the rate of good outcome (defined as the modified Rankin scale score at 3 months after onset) in patients treated with intravenous thrombolysis were compared before and after the implementation of telestroke. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes. Results The total rate of intravenous thrombolysis (7.99% vs. 2.88%; χ2=10.999, P=0.001) and the rate of intravenous thrombolysis in patients admitted within 3 h after onset (70.5% vs. 22.8%; χ2=22.930, P<0.001) in patients with acute ischemic stroke 1 year after the implementation of telestroke were significantly higher than those before telestroke. The average DTN time of intravenous thrombolysis at 1 year after the implementation of telestroke was shorter than before, but it did not reach statistical significance (70.55±28.52 min vs. 79.00±33.46 min; t=0.852, P=0.399). One year after the implementation of telestroke, the good outcome rate in patients treated with intravenous thrombolysis was significantly higher than before (80.65% vs. 46.15%; χ2=4.234, P=0.022). Multivariate logistic regression analysis showed that using telestroke was independently associated with the good outcome in the patients treated with intravenous thrombolysis (odds ratio 0.040, 95% confident interval 0.004-0.396; P=0.006). Conclusion Telestroke can improve the rate of intravenous thrombolysis and improve short-term outcomes in patients with acute ischemic stroke in remote areas. Key words: Stroke; Brain Ischemia; Thrombolytic Therapy; Tissue Plasminogen Activator; Telemedicine; Treatment Outcome