Introduction: rtPA thrombolysis still represents the primary therapy in acute stroke. Telestroke is likely the most promising tool to spread advanced care in stroke and to reduce the onset to needle time (ONT). In the last decade thousands of patients have been “telethrombolysed” in Europe, with good results in safety, efficacy and cost effectiveness (1). Following stroke societies' recommendations (2,3), the Telestroke Modena Project aims to offer rtPA therapy in the remote mountain areas, about as far as 1 h from our Stroke Unit.
Methods: The telemedical support consists of a digital network that included a 2-way video conference system, with high speed data transmission that allows stroke neurologists to see the patient and interact with internal physicians at Pavullo Hospital, Modena's Apennines. Brain CT scan is analyzed by a neuroradiologist on duty at Modena Hospital through an integrated RIS–PAC system. The enrollment is provided directly at a patient's home by a rescue team.
Results: From Jan. 2014 to Jan. 2015, 17 patients were included. After a complete evaluation following the standard “on label” criteria 6 patients were selected for “telethrombolysis” treatment with rtPA (5 m and 1 f; mean age: 73 years). We observed a neurological improvement in 5 patients (mean t0 NIH: 6; mean 24 h NIH: 1). 3 month mRS was 0–2 in 66% of patients. Mean onset to door time was 54′, door to needle time 56′ and ONT 123′. The hub results was respectively 64%, 78′, 67′ and 150′.
Conclusion: We found functional outcomes, complication rate and timing results comparable to our Stroke Unit, NINDS and SITS-MOST results.
1. Müller-Barna et al., TeleStroke units serving as a model of care in rural areas: 10-year experience of the TeleMedical project for integrative stroke care. Stroke. 2014;45(9):2739–44.
2. SPREAD V° edizione, 2007. Ictus cerebrale: Linee guida Italiane di prevenzione e trattamento.
3. Schwamm et al. Recommendation for the implementation of telemedicine within stroke systems of care: a policy statement from the American Stroke Association. Stroke 2009; 40; 2635–2660.
© 2015 Published by Elsevier Inc.