Abstract 2841: Intravenous Thrombolysis For Minor Strokes: Outcome In A Cohort Of Patients Treated Through Telemedicine
Objective: to determine the outcome of patients with minor strokes who receive intravenous thrombolysis in a telestroke network.
Background: The Arkansas SAVES (Stroke Assistance through Virtual Emergency Support) telestroke network provided emergency evaluation and therapy for acute stroke to 22 spoke sites statewide between November 2008 and May 2011. While there is little question regarding safety of IV thrombolysis in minor strokes, its impact on long-term outcome is equivocal. Few studies, yet with methodological problems attempted to answer this question.
Methods: Institutional IRB approval was obtained to review the prospective database of the Arkansas SAVES program. We included patients with admission NIHSS ≤ 4. They were divided into two groups based on whether or not they received IV thrombolysis. Baseline characteristics, risk factors, laboratory data and outcomes were compared between the two groups. Good outcome was defined as mRS < 2 and excellent outcome as mRS < 1, at 90 days. For statistical analysis, we used independent T, and fisher’s exact tests.
Results: The cohort included 562 patients receiving a teleconsultation between November 2008 and May 2011, of whom 116 underwent IV thrombolysis. Sixty patients with admission NIHSS ≤ 4 were included in this analysis. Patients who received IV thrombolysis had a trend towards a higher mean admission NIHSS (3.5 ± 0.7 vs. 3.9 ± 1.0, p = 0.085). There was no statistically significant difference in the percentage of good (76.7% vs. 73.3%, p = NS) or excellent outcome (60.0% vs. 56.7%, p = NS) between the two groups. The mean admission NIHSS was similar in patients with mRS<1 and mRS>1 (3.6 ± 0.9 vs. 3.7 ± 0.9, p = NS), possibly indicating a disconnect between stroke severity, when mild, and overall outcome.
Conclusion: Intravenous thrombolysis did not improve outcomes in patients with minimal deficits. The use of IV thrombolytics in patients with minor strokes should be individualized depending on the type of deficits and potential disability. A larger randomized trial is needed to confirm those results.
- © 2012 by American Heart Association, Inc.