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Published on: January 15, 2017
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Patients transferred within a telestroke network for large-vessel occlusion
Sujan T Reddy1,2, Sean I Savitz1,2, Elliott Friedman3
1Department of Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA.
Journal of Telemedicine and Telecare
|September 21, 2020
Summary
Many patients transferred for large-vessel occlusion (LVO) stroke treatment do not receive endovascular thrombectomy (EVT). Reasons include large infarcts, low stroke severity, or poor baseline function, highlighting the need for better imaging at referring hospitals.
Area of Science:
- Neurology
- Interventional Neurology
- Health Services Research
Background:
- Telestroke networks facilitate transfer of large-vessel occlusion (LVO) patients for endovascular thrombectomy (EVT) at comprehensive stroke centers (CSCs).
- A significant proportion of transferred patients do not ultimately undergo EVT after arrival at the CSC.
Purpose of the Study:
- To analyze the reasons why patients with suspected or confirmed LVO, transferred within a telestroke network, did not undergo EVT.
- To identify factors contributing to EVT ineligibility based on established guidelines.
Main Methods:
- Retrospective analysis of 400 patients with suspected or confirmed LVO transferred to a CSC within a 17-hospital telestroke network.
- Characterization of EVT ineligibility criteria using 2019 American Heart Association guidelines.
- Comparison of neuroimaging times between patients receiving different imaging protocols.
Main Results:
- 17% of transfers (68/400) were based on vascular imaging performed at the referring hospital (RH).
- Time to neuroimaging was longer for patients receiving both CT and CT angiography compared to CT alone (53 vs 13 minutes).
- Clinical suspicion for anterior circulation LVO (ACLVO) had 62% accuracy.
- Among 234 ACLVO patients, 74% were ineligible for EVT due to reasons like large core infarct, low NIHSS, distal occlusion, or poor baseline mRS.
Conclusions:
- Rapid acquisition and interpretation of vascular imaging for LVO detection at RHs are crucial.
- Establishing benchmarks for door-to-vascular imaging times at RHs is urgently needed to optimize patient selection for EVT.
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