Abstract
BackgroundTelestroke has developed rapidly as an assessment tool for patients eligible for reperfusion therapy.ObjectiveTo investigate whether vascular neurologists can diagnose intracranial large vessel occlusion (LVO) as quickly and accurately using a smartphone application compared to a hospital-based desktop PC monitor.MethodsWe retrospectively enrolled 108 consecutive patients with acute ischemic stroke in the middle cerebral artery territory who underwent magnetic resonance imaging (MRI) within 24 hours of their stroke onset. Two vascular neurologists, blinded to all clinical information, independently evaluated magnetic resonance angiography and fluid-attenuated inversion recovery images for the presence or absence of LVO in the internal carotid artery and middle cerebral artery (M1, M2, or M3) on both a smartphone application (Smartphone-LVO) and a hospital-based desktop PC monitor (PC-LVO). To evaluate the accuracy of an arterial occlusion diagnosis, interdevice variability between Smartphone-LVO and PC-LVO was analyzed using κ statistics, and image interpretation time was compared between Smartphone-LVO and PC-LVO.ResultsThere was broad agreement between Smartphone-LVO and PC-LVO evaluations regarding the presence or absence of arterial occlusion (Reader 1: κ=0.94; P<.001 vs Reader 2: κ=0.89; P<.001), and interpretation times were similar between Smartphone-LVO and PC-LVO.ConclusionsThe results indicate the evaluation of neuroimages using a smartphone application can provide an accurate and timely diagnosis of anterior intracranial arterial occlusion that can be shared immediately with members of the stroke team to support the management of patients with hyperacute ischemic stroke.
Highlights
In acute stroke management, early initiation is the most important factor in successful reperfusion therapy for both intravenous tissue plasminogen activator (IV-tPA) and mechanical thrombectomy (MT) [1,2] because the patient loses 1.9 million neurons every minute that a stroke is untreated [3]
Because “time is brain” in acute stroke treatment, the appropriate use of information and communication technology (ICT), telemedicine for stroke or “telestroke,” has become a valuable method for reaching out to patients who are eligible for IV-tPA and MT administration
Interdevice agreement for evaluating the presence or absence of intracranial arterial occlusion was almost perfect between Smartphone-large vessel occlusion (LVO) and PC-LVO (Reader 1: κ=0.94, 95% CI 0.82-0.97; P
Summary
Early initiation is the most important factor in successful reperfusion therapy for both intravenous tissue plasminogen activator (IV-tPA) and mechanical thrombectomy (MT) [1,2] because the patient loses 1.9 million neurons every minute that a stroke is untreated [3]. Because “time is brain” in acute stroke treatment, the appropriate use of information and communication technology (ICT), telemedicine for stroke or “telestroke,” has become a valuable method for reaching out to patients who are eligible for IV-tPA and MT administration. The JOIN smartphone application enables the multidisciplinary stroke team to share clinical information and imaging data securely. Through JOIN, the intrahospital network system sends medical images from the hospital server to a shared chat room accessible to stroke team members only, similar to modified teleradiology and teleconferencing (Figure 1). It is complementary to the telestroke system, as an image evaluation tool [4]. Telestroke has developed rapidly as an assessment tool for patients eligible for reperfusion therapy
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