title: Drip-and-Ship Thrombolytic Therapy Supported by the Telestroke System for Acute Ischemic Stroke Patients Living in Medically Under-served Areas.
abstract: There are a few stroke specialists in medically under-served areas in Japan. Consequently, in remote area patients may not receive thrombolysis with intravenous recombinant tissue plasminogen activator (iv rt-PA), the standard treatment for acute ischemic stroke. Using a mobile telestroke support system (TSS) that accesses the internet via a smart phone, we implemented iv rt-PA infusion therapy under a drip-and-ship protocol to treat the stroke patients in medically under-served areas. The physicians at the Tokushima Prefectural Kaifu Hospital (TPKH), located in rural Japan, can relay CT or MRI scans and other patient data via their smart phone to off-site stroke specialists. In the course of 34 months, we used the TSS in 321 emergencies. A total of 9 of 188 (4.8%) with acute ischemic stroke, received iv rt-PA infusion therapy using a mobile TSS; in 5 among these (55.6%), we obtained partial or complete recanalization of occluded arteries. None suffered post-treatment hemorrhage and their average NIH stroke score fell from 14.6 at the time of admission to 6.8 at 24 h post-infusion. The drip-and-ship protocol contributed to the safe and effective treatment of the stroke patients living in medically under-served rural areas.
authors.affiliation: Department of Neurosurgery, Tokushima Prefectural Kaifu Hospital.
authors.forename: Teruyoshi
authors.initials: T
authors.lastname: Kageji
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Obata
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Oka
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Kanematsu
authors.forename: Ryo
authors.initials: R
authors.lastname: Tabata
authors.forename: Kenji
authors.initials: K
authors.lastname: Tani
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Bando
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007564:Japan; D008297:Male; D008507:Medically Underserved Area; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D017216:Telemedicine; D015912:Thrombolytic Therapy; D061665:Time-to-Treatment; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator