Affordable Access

deepdyve-link
Publisher Website

Implementation of multimodal computed tomography in a telestroke network: Five-year experience.

Authors
  • Garcia-Esperon, Carlos1, 2
  • Soderhjelm Dinkelspiel, Frode3
  • Miteff, Ferdi1, 2
  • Gangadharan, Shyam1, 2
  • Wellings, Tom1, 2
  • O Brien, Bill4
  • Evans, James4
  • Lillicrap, Tom1, 2
  • Demeestere, Jelle5
  • Bivard, Andrew6
  • Parsons, Mark2, 6
  • Levi, Chris
  • Spratt, Neil James1, 2
  • 1 Department of Neurology, John Hunter Hospital, Hunter New England Local Health District, Newcastle, NSW, Australia. , (Australia)
  • 2 Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia. , (Australia)
  • 3 Karolinska Institutet, Stockholm, Sweden. , (Sweden)
  • 4 Neurosciences Department, Gosford Hospital, Central Coast Local Health District, Gosford, NSW, Australia. , (Australia)
  • 5 Neurology Department, Leuven University Hospital, Leuven, Belgium. , (Belgium)
  • 6 Department of Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia. , (Australia)
Type
Published Article
Journal
CNS Neuroscience & Therapeutics
Publisher
Wiley (Blackwell Publishing)
Publication Date
Mar 01, 2020
Volume
26
Issue
3
Pages
367–373
Identifiers
DOI: 10.1111/cns.13224
PMID: 31568661
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Penumbral selection is best-evidence practice for thrombectomy in the 6-24 hour window. Moreover, it helps to identify the best responders to thrombolysis. Multimodal computed tomography (mCT) at the primary centre-including noncontrast CT, CT perfusion, and CT angiography-may enhance reperfusion therapy decision-making. We developed a network with five spoke primary stroke sites and assessed safety, feasibility, and influence of mCT in rural hospitals on decision-making for thrombolysis. Consecutive patients assessed via telemedicine from April 2013 to June 2018. Clinical outcomes were measured, and decision-making compared using theoretical models for reperfusion therapy applied without mCT guidance. Symptomatic intracranial hemorrhage (sICH) was assessed according to Safe Implementation of Treatments in Stroke Thrombolysis Registry criteria. A total of 334 patients were assessed, 240 received mCT, 58 were thrombolysed (24.2%). The mean age of thrombolysed patients was 70 years, median baseline National Institutes of Health Stroke Scale was 10 (IQR 7-18) and 23 (39.7%) had a large vessel occlusion. 1.7% had sICH and 3.5% parenchymal hematoma. Three months poststroke, 55% were independent, compared with 70% in the non-thrombolysed group. Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH. © 2019 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

Report this publication

Statistics

Seen <100 times