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

CNS Neurosci Ther. 2020 Mar;26(3):367-373. doi: 10.1111/cns.13224. Epub 2019 Sep 30.

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.

Keywords: CT perfusion; acute stroke therapy; core; multimodal CT; penumbra; telestroke.

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cohort Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging / methods*
  • New South Wales / epidemiology
  • Prospective Studies
  • Retrospective Studies
  • Stroke / diagnostic imaging*
  • Stroke / epidemiology
  • Stroke / therapy*
  • Telemedicine / methods*
  • Thrombolytic Therapy / methods*
  • Time Factors
  • Tomography, X-Ray Computed / methods*