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


METHODS
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.


RESULTS
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.


CONCLUSION
Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH.
['Garcia-Esperon|Carlos|C|0000-0001-8843-5890', 'Soderhjelm Dinkelspiel|Frode|F|', 'Miteff|Ferdi|F|', 'Gangadharan|Shyam|S|', 'Wellings|Tom|T|', 'O Brien|Bill|B|', 'Evans|James|J|', 'Lillicrap|Tom|T|', 'Demeestere|Jelle|J|', 'Bivard|Andrew|A|', 'Parsons|Mark|M|', 'Levi|Chris|C|', 'Spratt|Neil James|NJ|', '|||']
D000368:Aged D000369:Aged, 80 and over D015331:Cohort Studies D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D064847:Multimodal Imaging D009517:New South Wales D011446:Prospective Studies D012189:Retrospective Studies D020521:Stroke D017216:Telemedicine D015912:Thrombolytic Therapy D013997:Time Factors D014057:Tomography, X-Ray Computed
telestroke CT perfusion acute stroke therapy core multimodal CT penumbra