title: Telestroke in South Carolina.
abstract: BACKGROUND
  The administration of thrombolysis to eligible patients is often limited to centers with expertise. This study was intended to report on the safety and efficacy (in increasing thrombolysis availability) of telemedicine in the acute assessment and treatment of stroke patients presenting to hospitals in distant locations from a designated stroke center.
  
  
  METHODS
  A web-based telestroke tool (remote evaluation of acute ischemic stroke at Medical University of South Carolina [REACH-MUSC]), was implemented to provide acute stroke care 24 hours per day, 7 days per week to 12 community hospitals in South Carolina.
  
  
  RESULTS
  Nine hundred sixty-five consults were performed. Among the 525 patients with a National Institutes of Health Stroke Score >3, 185 (35.7%) were treated with intravenous tissue plasminogen activator (t-PA) alone, 15 (2.9%) received combination of intravenous and intra-arterial thrombolysis/thrombectomy, and 11 (2.1%) were treated with intra-arterial therapy alone. Of those who received intravenous t-PA, 119 (64.3%) were transferred to the hub; the medians (interquartile range) for onset to treatment for the intravenous t-PA and the intravenous t-PA and intra-arterial groups were 152 (range 115-193) minutes and 147 (range 107-179) minutes, respectively. Three patients (1.6%) who received intravenous t-PA alone experienced symptomatic intracerebral hemorrhage. The most common reason for not receiving thrombolysis was patient presentation outside the time window for treatment.
  
  
  CONCLUSIONS
  Telestroke can have a major impact in increasing thrombolysis rates in remote areas from specialized centers, and in particular in areas where t-PA is underutilized.
authors.affiliation: Division of Vascular Neurology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina; Division of Neurocritical Care, Department of Neurosciences, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: lazaridi@musc.edu.
authors.forename: Christos
authors.initials: C
authors.lastname: Lazaridis
authors.forename: Stacia M
authors.initials: SM
authors.lastname: DeSantis
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis* / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D013022:South Carolina; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy*; D017216:Telemedicine; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator