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

Area of Science:

• Neurology
• Radiology
• Emergency Medicine

Background:

• Penumbral selection is crucial for thrombectomy in the 6-24 hour window.
• Multimodal computed tomography (mCT), including CT perfusion (CTP), aids in identifying stroke reperfusion therapy candidates.
• Implementing advanced imaging in rural settings presents unique challenges.

Purpose of the Study:

• To assess the safety, feasibility, and impact of mCT on thrombolysis decision-making in rural hospitals.
• To evaluate the effectiveness of telemedicine-assisted mCT in a spoke-and-hub network.
• To compare clinical outcomes and reperfusion therapy decisions with and without mCT guidance.

Main Methods:

• A network of five primary stroke sites utilized telemedicine for patient assessment from April 2013 to June 2018.
• Consecutive patients underwent assessment, with a subset receiving mCT (noncontrast CT, CT perfusion, CT angiography).
• Clinical outcomes and symptomatic intracranial hemorrhage (sICH) rates were recorded and compared to theoretical models.

Main Results:

• 334 patients were assessed; 240 received mCT, and 58 (24.2%) were thrombolysed.
• Thrombolysed patients had a mean age of 70, median NIHSS of 10, and 39.7% had large vessel occlusion.
• Low rates of sICH (1.7%) and parenchymal hematoma (3.5%) were observed. Three-month independence was 55% in the thrombolysed group versus 70% in the non-thrombolysed group.

Conclusions:

• CT perfusion (CTP) implementation in rural centers is feasible.
• This approach facilitates high thrombolysis rates.
• Low rates of symptomatic intracranial hemorrhage (sICH) were achieved, indicating a safe and effective strategy.