Telemedicine in acute stroke care: the TESSA model

We conducted a retrospective controlled study to assess the safety and effectiveness of intravenous thrombolysis via videoconferencing, followed by patient transport to a specialized stroke unit. Between 2006 and 2009, 47 stroke patients were treated in peripheral hospitals in the county of Salzburg in Austria by intravenous thrombolysis via telemedicine; 304 patients who were treated with intravenous thrombolysis at a stroke unit served as the control group. The mean age of the patients was 67 years in the telemedicine group and 71 years in the control group. Haemorrhagic bleeding occurred in 6.4% of the telemedicine group compared to 7.6% of the control group. The mean onset-to-needle time was 113 min in the telemedicine group and 122 min in the control group (P = 0.263). At three-month follow-up, 47% of the patients in the telemedicine group had good functional outcomes (mRS, dichotomized analysis 0-1) versus 43% in the control group (P = 0.694). The overall mortality at three-month follow-up was 19% in the telemedicine group and 13% in the control group (P = 0.248). Telemedicine can be used to support regional areas with little experience in delivering intravenous thrombolysis, thus raising the standard of stroke care and minimizing inequalities.