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Title: Implementation of multimodal computed tomography in a telestroke network: Five-year experience
Authors: O'Brien, Bill
Evans, James
Garcia-Esperon, C.
Soderhjelm Dinkelspiel, F.
Miteff, F.
Gangadharan, S.
Wellings, T.
Lillicrap, T.
Demeestere, J.
Bivard, A.
Parsons, M.
Levi, C.
Spratt, N.J.
Keywords: Neurology;Brain;Stroke
Year: Sep-2019
Citation: Epub ahead of print
Abstract: 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.
ISSN: 1755-5930
DOI: 10.1111/cns.13224
Journal Title: CNS Neuroscience & Therapeutics
Appears in Collections:Neurology

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