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Updated: Jun 11, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Prehospital computed tomography in a rural district for rapid diagnosis and treatment of stroke
Jørgen Ibsen1, Maren Ranhoff Hov2,3, Gunn Eli Tokerud4
1Department of Medicine, Ringerike Hospital, Vestre Viken Hospital Trust, Honefoss, Norway.
Insights
Implementing rural CT scans and telestroke services significantly speeds up diagnosis and treatment for ischemic stroke patients in remote areas. This approach enables faster reperfusion therapy, improving outcomes for stroke care.
Area of Science:
- Neurology
- Emergency Medicine
- Radiology
Background:
- Early diagnosis and triage are critical for effective ischemic stroke reperfusion therapy.
- Rural patients often face significant prehospital delays, missing the window for timely thrombolytic treatment.
- Prolonged transport times to stroke centers hinder rapid intervention.
Purpose of the Study:
- To evaluate the feasibility of establishing emergency pathways for CT imaging and thrombolytic treatment in a rural setting.
- To assess the impact of a de novo rural CT concept on diagnosis and treatment times for acute ischemic stroke.
- To compare outcomes between patients treated with rural CT and telestroke support versus those without.
Main Methods:
- A comparative cohort observational study was conducted at Hallingdal District Medical Centre (HDMC) in rural Norway (2017-2021).
- Patients in the Rural CT group underwent prehospital CT imaging and telestroke-guided treatment.
- The Rural CT group was compared to a Reference group from similar rural regions without rural CT access.
Main Results:
- Median time to CT completion was significantly shorter in the Rural CT group (93 min) compared to the Reference group (240 min).
- Time from symptom onset to thrombolysis treatment was also significantly reduced in the Rural CT group (124 min vs. 213 min).
- No significant difference was observed in the frequency of thrombolysis administration between the two groups.
Conclusions:
- Prehospital rural CT examination combined with telestroke guidance facilitates earlier thrombolysis initiation for ischemic stroke.
- This integrated approach can overcome geographical barriers and reduce delays in critical stroke care.
- The model demonstrates potential for improving access to time-sensitive stroke treatments in underserved rural populations.
Background:
Early diagnosis and triage of patients with ischemic stroke is essential for rapid reperfusion therapy. The prehospital delay may be substantial and patients from rural districts often arrive at their local hospital too late for disability-preventing thrombolytic therapy due to prolonged transport times.
Methods:
Hallingdal District Medical Centre (HDMC) is located in a rural area of Norway and is equipped with a computed tomography (CT) scanner. We established emergency pathways of CT imaging and thrombolytic treatment of patients with acute ischemic stroke at HDMC. During office hours these pathways were managed by a radiographer and a general physician supported by videoconference from the Primary Stroke Centre. Outside office hours we remotely controlled the CT exam and supported telestroke guided paramedics handling and examining the patients. With a primary aim of demonstrating the feasibility of this de novo concept we enrolled patients in the period 2017-2021 into a comparative cohort observational study. We compared patients treated at HDMC (the Rural CT group) to patients from two other rural regions in Norway with similar distances to their local hospital but without access to a rural CT scanner (the Reference group).
Results:
A total of 86 patients were included in the Rural CT group (mean age 74, 52% male, 43% stroke mimics), and 69 patients were included in the Reference group (mean age 70, 42% male, 28% stroke mimics). Median time from onset of symptoms to completed CT examination was 93 min in the Rural CT group as compared to 240 min in the Reference group (p < 0.05). In patients receiving intravenous thrombolysis time from onset of symptoms to treatment was median 124 min in the Rural CT group and 213 min in the Reference group, p < 0.05. The frequency of thrombolysis for ischemic stroke did not significantly differ between the two groups.
Conclusion:
Combining prehospital rural CT examination with telestroke guided diagnosis and thrombolytic treatment by paramedics may facilitate earlier initiation of thrombolysis for patients with ischemic stroke.
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