Abstract Details

Title Patient Safety and Outcomes after Thrombolysis within a 4.5 Hour Window Via Telestroke Network

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 179

Objective

Background BACKGROUND: Significant growth in telemedicine provides improved access to acute stroke care in rural settings, especially facilitating increased rates of intravenous thrombolysis. Whether similar good outcomes can be achieved within a 4.5 hour window is unknown.

Design/Methods DESIGN/METHODS: This is a retrospective cohort study of consecutive acute ischemic stroke patients from January 2010 through August 2012 who received IV thrombolyis within 4.5 hours of symptom onset. Patients who received IV thrombolysis via the WFBH Telestroke network and then transferred to the hub stroke center were compared to patients seen and treated at the hub center directly. The medical records and imaging of all patients were reviewed to assess outcomes and complications.

Results RESULTS: Forty-nine patients received thrombolysis at the network hospitals and 63 patients were treated directly at the hub hospital. Overall demographics were similar between the groups except that more patients at the spoke hospitals were white (p<0.001). The median time from onset to treatment for network patients was 158 minutes, compared to 152 minutes for patients treated at the hub stroke center (p=0.57). Fourteen patients (28.6%) in the network group and 19 patients (30.2%) in the hub group received thrombolysis beyond the 3 hour window. Symptomatic intracranial hemorrhage rate was nearly identical (8.1 and 8.2%) for both groups. There were no significant differences between the groups for in- hospital mortality, systemic bleeding, discharge disposition and readmission rate. Length of stay was shorter in the network group at 3 days (range 1-25) compared to 5 days (range 1-29) in the hub group (p=0.011).

Conclusions CONCLUSIONS: This study confirms that IV thrombolysis within a 4.5 hour window can be performed safely and effectively through a telemedicine network with outcomes similar to what can be obtained treating patients directly at an academic stroke center.

Authors/Disclosures
Sureerat Suwatcharangkoon, MD (Faculty of Medicine Ramathibodi Hospital) PRESENTER	No disclosure on file
Mark C. Cascione, MD (Tampa Neurology Associates)	No disclosure on file
Patrick S. Reynolds, MD, FAAN (Wake Forest University Health Sciences)	Dr. Reynolds has nothing to disclose.

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