Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window

Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic str...

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Autores principales:	Erik Simon, Matin Forghani, Andrij Abramyuk, Simon Winzer, Claudia Wojciechowski, Lars-Peder Pallesen, Timo Siepmann, Heinz Reichmann, Volker Puetz, Kristian Barlinn, Jessica Barlinn
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	telemedicine thrombolysis stroke acute stroke therapy stroke network Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/04612c12d35e462d887a2f91119797d1
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spelling	oai:doaj.org-article:04612c12d35e462d887a2f91119797d12021-12-01T06:35:24ZIntravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window1664-229510.3389/fneur.2021.756062https://doaj.org/article/04612c12d35e462d887a2f91119797d12021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.756062/fullhttps://doaj.org/toc/1664-2295Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network.Methods: Observational study of patients with AIS who received IVT at the Stroke Eastern Saxony Telemedical Network between 01/2014 and 12/2015. We compared safety data including symptomatic intracerebral hemorrhage (sICH; according to European Cooperative Acute Stroke Study II definition) and any intracerebral hemorrhage (ICH) between patients admitted to telestroke spoke sites and patients directly admitted to a tertiary stroke center representing the hub of the network. We also assessed short-term efficacy data including favorable functional outcome (i.e., modified Rankin Scale ≤ 2) and National Institutes of Health Stroke Scale (NIHSS) at discharge, hospital discharge disposition, and in-hospital mortality.Results: In total, 152 patients with AIS were treated with IVT in the expanded time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]. Patients treated at spoke sites had less frequently a large vessel occlusion [8/104 (7.7) vs. 20/48 (41.7%); p < 0.0001], a determined stroke etiology (p < 0.0001) and had slightly shorter onset-to-treatment times [210 (45) vs. 228 (58) min; p = 0.02] than patients who presented to the hub site. Both cohorts did not display any further differences in demographics, vascular risk factors, median baseline NIHSS scores, or median baseline Alberta stroke program early CT score (p > 0.05). There was no difference in the frequency of sICH (4.9 vs. 6.3%; p = 0.71) or any ICH (8.7 vs. 16.7%; p = 0.15). Neither there was a difference regarding favorable functional outcome (44.1 vs. 39.6%; p = 0.6) nor median NIHSS [3 (5.5) vs. 2.5 (5.75); p = 0.92] at discharge, hospital discharge disposition (p = 0.28), or in-hospital mortality (9.6 vs. 8.3%; p = 1.0). Multivariable modeling did not reveal an association between telestroke and sICH or favorable functional outcome (p > 0.05).Conclusions: Delivery of IVT in the expanded 3- to 4.5-h time window through a telestroke network appears to be safe with equivalent short-term functional outcomes for spoke-and-hub center admissions.Erik SimonMatin ForghaniAndrij AbramyukSimon WinzerClaudia WojciechowskiLars-Peder PallesenTimo SiepmannHeinz ReichmannVolker PuetzKristian BarlinnJessica BarlinnFrontiers Media S.A.articletelemedicinethrombolysisstrokeacute stroke therapystroke networkNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	telemedicine thrombolysis stroke acute stroke therapy stroke network Neurology. Diseases of the nervous system RC346-429
spellingShingle	telemedicine thrombolysis stroke acute stroke therapy stroke network Neurology. Diseases of the nervous system RC346-429 Erik Simon Matin Forghani Andrij Abramyuk Simon Winzer Claudia Wojciechowski Lars-Peder Pallesen Timo Siepmann Heinz Reichmann Volker Puetz Kristian Barlinn Jessica Barlinn Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window
description	Background: While intravenous thrombolysis (IVT) in ischemic stroke can be safely applied in telestroke networks within 3 h from symptom onset, there is a lack of evidence for safety in the expanded 3- to 4. 5-h time window. We assessed the safety and short-term efficacy of IVT in acute ischemic stroke (AIS) in the expanded time window delivered through a hub-and-spoke telestroke network.Methods: Observational study of patients with AIS who received IVT at the Stroke Eastern Saxony Telemedical Network between 01/2014 and 12/2015. We compared safety data including symptomatic intracerebral hemorrhage (sICH; according to European Cooperative Acute Stroke Study II definition) and any intracerebral hemorrhage (ICH) between patients admitted to telestroke spoke sites and patients directly admitted to a tertiary stroke center representing the hub of the network. We also assessed short-term efficacy data including favorable functional outcome (i.e., modified Rankin Scale ≤ 2) and National Institutes of Health Stroke Scale (NIHSS) at discharge, hospital discharge disposition, and in-hospital mortality.Results: In total, 152 patients with AIS were treated with IVT in the expanded time window [spoke sites, n = 104 (26.9%); hub site, n = 48 (25.9%)]. Patients treated at spoke sites had less frequently a large vessel occlusion [8/104 (7.7) vs. 20/48 (41.7%); p < 0.0001], a determined stroke etiology (p < 0.0001) and had slightly shorter onset-to-treatment times [210 (45) vs. 228 (58) min; p = 0.02] than patients who presented to the hub site. Both cohorts did not display any further differences in demographics, vascular risk factors, median baseline NIHSS scores, or median baseline Alberta stroke program early CT score (p > 0.05). There was no difference in the frequency of sICH (4.9 vs. 6.3%; p = 0.71) or any ICH (8.7 vs. 16.7%; p = 0.15). Neither there was a difference regarding favorable functional outcome (44.1 vs. 39.6%; p = 0.6) nor median NIHSS [3 (5.5) vs. 2.5 (5.75); p = 0.92] at discharge, hospital discharge disposition (p = 0.28), or in-hospital mortality (9.6 vs. 8.3%; p = 1.0). Multivariable modeling did not reveal an association between telestroke and sICH or favorable functional outcome (p > 0.05).Conclusions: Delivery of IVT in the expanded 3- to 4.5-h time window through a telestroke network appears to be safe with equivalent short-term functional outcomes for spoke-and-hub center admissions.
format	article
author	Erik Simon Matin Forghani Andrij Abramyuk Simon Winzer Claudia Wojciechowski Lars-Peder Pallesen Timo Siepmann Heinz Reichmann Volker Puetz Kristian Barlinn Jessica Barlinn
author_facet	Erik Simon Matin Forghani Andrij Abramyuk Simon Winzer Claudia Wojciechowski Lars-Peder Pallesen Timo Siepmann Heinz Reichmann Volker Puetz Kristian Barlinn Jessica Barlinn
author_sort	Erik Simon
title	Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window
title_short	Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window
title_full	Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window
title_fullStr	Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window
title_full_unstemmed	Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window
title_sort	intravenous thrombolysis by telestroke in the 3- to 4.5-h time window
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/04612c12d35e462d887a2f91119797d1
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Intravenous Thrombolysis by Telestroke in the 3- to 4.5-h Time Window

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