title: Acute endovascular treatment delivery to ischemic stroke patients transferred within a telestroke network: a retrospective observational study.
abstract: Background Five randomized controlled trials recently demonstrated efficacy of endovascular treatment in acute ischemic stroke. Telestroke networks can improve stroke care in rural areas but their role in patients undergoing endovascular treatment is unknown. Aim We compared clinical outcomes of endovascular treatment between anterior circulation stroke patients transferred after teleconsultation and those directly admitted to a tertiary stroke center. Methods Data derived from consecutive patients with intracranial large vessel occlusion who underwent endovascular treatment from January 2010 to December 2014 at our tertiary stroke center. We compared baseline characteristics, onset-to-treatment times, symptomatic intracranial hemorrhage, in-hospital mortality, reperfusion (modified Treatment in Cerebral Infarction 2b/3), and favorable functional outcome (modified Rankin scale ≤ 2) at discharge between patients transferred from spoke hospitals and those directly admitted. Results We studied 151 patients who underwent emergent endovascular treatment for anterior circulation stroke: median age 70 years (interquartile range, 62-75); 55% men; median National Institutes of Health Stroke Scale score 15 (12-20). Of these, 48 (31.8%) patients were transferred after teleconsultation and 103 (68.2%) were primarily admitted to our emergency department. Transferred patients were younger (p = 0.020), received more frequently intravenous tissue plasminogen activator (p = 0.008), had prolonged time from stroke onset to endovascular treatment initiation (p < 0.0001) and tended to have lower rates of symptomatic intracranial hemorrhage (4.2% vs. 11.7%; p = 0.227) and mortality (8.3% vs. 22.6%; p = 0.041) than directly admitted patients. Similar rates of reperfusion (56.2% vs. 61.2%; p = 0.567) and favorable functional outcome (18.8% vs. 13.7%; p = 0.470) were observed in telestroke patients and those who were directly admitted. Conclusions Telestroke networks may enable delivery of endovascular treatment to selected ischemic stroke patients transferred from remote hospitals that is equitable to patients admitted directly to tertiary hospitals.
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Barlinn
authors.affiliation: 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Gerber
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Lars-Peder
authors.initials: LP
authors.lastname: Pallesen
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Timo
authors.initials: T
authors.lastname: Siepmann
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Zerna
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Wojciechowski
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.affiliation: 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: von Kummer
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
authors.affiliation: 2 Department of Neuroradiology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linn
authors.affiliation: 1 Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000150:complications / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010360:Patient Transfer; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017216:Telemedicine; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Acute stroke therapy; intervention; ischemic stroke; telemedicine