Abstract

Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network.Methods: Observational study of patients with AIS who received IVT at the Stroke Eastern Saxony Telemedical Network between 01/2014 and 12/2015. We compared safety data including symptomatic intracerebral hemorrhage (sICH; according to European Cooperative Acute Stroke Study II definition) and any intracerebral hemorrhage (ICH) between patients admitted to telestroke spoke sites and patients directly admitted to a tertiary stroke center representing the hub of the network. We also assessed short-term efficacy data including favorable functional outcome (i.e., modified Rankin Scale ≤ 2) and National Institutes of Health Stroke Scale (NIHSS) at discharge, hospital discharge disposition, and in-hospital mortality.Results: In total, 152 patients with AIS were treated with IVT in the expanded time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]. Patients treated at spoke sites had less frequently a large vessel occlusion [8/104 (7.7) vs. 20/48 (41.7%); p < 0.0001], a determined stroke etiology (p < 0.0001) and had slightly shorter onset-to-treatment times [210 (45) vs. 228 (58) min; p = 0.02] than patients who presented to the hub site. Both cohorts did not display any further differences in demographics, vascular risk factors, median baseline NIHSS scores, or median baseline Alberta stroke program early CT score (p > 0.05). There was no difference in the frequency of sICH (4.9 vs. 6.3%; p = 0.71) or any ICH (8.7 vs. 16.7%; p = 0.15). Neither there was a difference regarding favorable functional outcome (44.1 vs. 39.6%; p = 0.6) nor median NIHSS [3 (5.5) vs. 2.5 (5.75); p = 0.92] at discharge, hospital discharge disposition (p = 0.28), or in-hospital mortality (9.6 vs. 8.3%; p = 1.0). Multivariable modeling did not reveal an association between telestroke and sICH or favorable functional outcome (p > 0.05).Conclusions: Delivery of IVT in the expanded 3- to 4.5-h time window through a telestroke network appears to be safe with equivalent short-term functional outcomes for spoke-and-hub center admissions.

Highlights

  • The implementation of endovascular therapy (EVT) in the treatment of acute ischemic stroke (AIS) has a largely improved prognosis of the disease, intravenous thrombolysis (IVT) using tissue plasminogen activator continues to be the mainstay of acute care of patients with AIS and remains of great importance for prevention of long-term disability [1, 2]

  • We have recently shown that IVT delivered through telestroke network is not inferior in terms of safety and efficacy to tissuetype plasminogen activator provided at specialized stroke centers for the treatment of AIS in the 3-h time window [9]

  • The final study population consisted of 152 patients with AIS who were treated in the 3- to 4.5-h time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]

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Summary

Introduction

The implementation of endovascular therapy (EVT) in the treatment of acute ischemic stroke (AIS) has a largely improved prognosis of the disease, intravenous thrombolysis (IVT) using tissue plasminogen activator continues to be the mainstay of acute care of patients with AIS and remains of great importance for prevention of long-term disability [1, 2]. While recent data even suggest a benefit of IVT up to 9 h from symptom onset using advanced imaging techniques that are commonly reserved to dedicated stroke centers, there is still a lack of evidence regarding its safety and efficacy in the regularly approved 3- to 4.5-h therapeutic time window in the telestroke setting [9,10,11,12]. In view of these considerations, we aimed to investigate the safety and short-term efficacy of IVT in the 3- to 4.5-h time window for treatment of AIS in a telestroke network. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network

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