Abstract T P207: TeleStroke Systems Preclude Access to Endovascular Procedures in Acute Stroke Patients
Telestroke systems as we know them today imply transfer of acute stroke codes to Community Hospitals (CommH) that cannot offer endovascular procedures (EVT). The aimed benefit of this policy relies on the fact that 1) iv-tPA may be offered earlier and 2) unnecessary transfers to Comprehensive stroke centers (CSC) can be avoided. On the other hand this strategy may generate a time delay in potential candidates for endovascular procedures. We aimed to quantify these potential benefits and disadvantages.
Methods: From march 2013 to march 2014, 533 teleconsults were centrally attended by a stroke neurologist in the Catalan telestroke system that covers 8 centers with no endovascular facilities. Mean distance from CommH to referral CSC was 60 km. We defined criteria to identify potential candidates for EVT in the field (<81 years & NIHSS>8 & <8 hours from symptom onset) or in the ComH after teleconsultation (excluding ICH, ASPECTS<7, lacunar syndroms).
Results: From the 533 patients, 84 (17%) could be identified on-field before arrival to Community Hospital as potential candidates for EVT. Once at the CommH, from these 84 patients, 60 (71%) were still potential candidates for EVT after CT-scan and teleconsultation.Of these 84 patients, only 27 (32%) received iv-TPA in the CommH, however 68 (80%) were still transferred to the CSC, where only 15 (18%) were finally treated with EVT. The median time from ComH-door to groin puncture was 216 min Vs door-to-groin 152 min for primary admissions at the CSC (p<0.01).
Conclusions: Telestroke systems as we know them today offer safe and timely iv-tPA treatment to eligible patients but may induce a considerable time loss in most EVT candidates. Only one third of the on-field potential EVT candidates benefit from admission in a CommH by being treated with iv-tPA while more than ¾ will still be transferred to the CSC. New technologies allowing on the field telestroke triage could identify those patients suitable for primary transfer to CSC.
Author Disclosures: M. Ribo: None. N. Perez de la Ossa: None. P. Cardona: None. S. Abilleira: None. C.A. Molina: None.
- © 2015 by American Heart Association, Inc.