Abstract Details

Title Administration of tPA within 60 Minutes Is Feasible Using the Telestroke Model

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 230

Objective

Background BACKGROUND: Telestroke for acute stroke care is recommended in hospitals without bedside neurological expertise, to increase the utilization of intravenous tPA. The benefits from tPA are maximum if administered within 60 minutes of a patient's arrival at the emergency room. Stroke systems are geared towards providing organized and efficient stroke care to patients to achieve this target.

Design/Methods DESIGN/METHODS: The Michigan Stroke Network is a telestroke system that provides acute stroke expertise across 32 hospitals within the state of Michigan. About one-fifth of member hospitals have primary stroke center certification. Patients receiving tPA following a two way audio-video consultation are followed concurrently and data regarding time of symptom onset, time of arrival, time of pager activation, time of telemedicine consultation and time of tPA administration are gathered for quality improvement. Proportion of patients receiving tPA after a telestroke consultation, within 60 minutes of arrival at the member hospitals was reviewed.

Results RESULTS: Over 8 months (Jan 2012 through August 2012) 36 patients at member hospitals received intravenous tPA after a video consultation. Half (50%) of the consultations achieved a door to needle time < 60 minutes. This is notably higher than the nationwide proportion of 29% among Get With the Guideline hospitals. The fastest case in the present dataset received tPA within 28 minutes of arrival. Early activation of the network pager by emergency physicians at the member hospitals helped reduce door to needle times.

Conclusions CONCLUSIONS: Door to needle times less than 60 minutes can be achieved using a telestroke model. Telemedicine not only improves tPA utilization, but can also be used to administer tPA more efficiently and effectively. Further data collection on network patients is ongoing and will be presented.

Authors/Disclosures
Pratik D. Bhattacharya, MD, MPH (International Medical Clinic) PRESENTER	Dr. Bhattacharya has a non-compensated relationship as a Research Advisor with Defeat MSA Alliance 501 (c) (3) that is relevant to AAN interests or activities.
	No disclosure on file
	No disclosure on file
Seemant Chaturvedi, MD, FAHA, FAAN (University of Maryland)	Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Chaturvedi has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Chaturvedi has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Chaturvedi has received research support from NINDS.
Kumar Rajamani, MD, FAAN	Dr. Rajamani has nothing to disclose.
Gregory Norris, MD (DetroitBrainInstitute)	No disclosure on file
	No disclosure on file
Ramesh Madhavan, MD, FAAN (International Medical Clinic)	Dr. Madhavan has received stock or an ownership interest from TiaTech USA and TiaTech India. Dr. Madhavan has received intellectual property interests from a discovery or technology relating to health care.

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