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

被引:19
作者
Garcia-Esperon, Carlos [1 ,2 ,3 ]
Dinkelspiel, Frode Soderhjelm [4 ]
Miteff, Ferdi [1 ,2 ,3 ]
Gangadharan, Shyam [1 ,2 ,3 ]
Wellings, Tom [1 ,2 ,3 ]
O'Brien, Bill [5 ]
Evans, James [5 ]
Lillicrap, Tom [1 ,2 ,3 ]
Demeestere, Jelle [6 ]
Bivard, Andrew [7 ]
Parsons, Mark [2 ,3 ,7 ]
Levi, Chris
Spratt, Neil James [1 ,2 ,3 ]
Peake, Rachel
Hughes, James
Dark, Lisa
Ryan, Nick
Shepherd, Matt
Ali, Osama
Wills, James
Minett, Fiona
Birnie, Jaclyn
Buzio, Amanda
Bruce, Iain
Tankel, Alan
Parrey, Kim
Kinchington, Matthew
Pepper, Elizabeth
Loiselle, Andre
Waller, Sophie
Chew, Alvin
Russell, Michelle
Royan, Angela
Roworth, Brett
机构
[1] Hunter New England Local Hlth Dist, John Hunter Hosp, Dept Neurol, Newcastle, NSW, Australia
[2] Hunter Med Res Inst, Newcastle, NSW, Australia
[3] Univ Newcastle, Newcastle, NSW, Australia
[4] Karolinska Inst, Stockholm, Sweden
[5] Cent Coast Local Hlth Dist, Gosford Hosp, Neurosci Dept, Gosford, NSW, Australia
[6] Leuven Univ Hosp, Neurol Dept, Leuven, Belgium
[7] Univ Melbourne, Royal Melbourne Hosp, Melbourne Brain Ctr, Dept Neurol, Parkville, Vic, Australia
基金
英国医学研究理事会; 澳大利亚国家健康与医学研究理事会;
关键词
acute stroke therapy; core; CT perfusion; multimodal CT; penumbra; telestroke; ACUTE ISCHEMIC-STROKE; HEALTH-CARE PROFESSIONALS; PERFUSION; THROMBOLYSIS; TELEMEDICINE; MANAGEMENT; EFFICACY; CT;
D O I
10.1111/cns.13224
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Aims Penumbral selection is best-evidence practice for thrombectomy in the 6-24 hour window. Moreover, it helps to identify the best responders to thrombolysis. Multimodal computed tomography (mCT) at the primary centre-including noncontrast CT, CT perfusion, and CT angiography-may enhance reperfusion therapy decision-making. We developed a network with five spoke primary stroke sites and assessed safety, feasibility, and influence of mCT in rural hospitals on decision-making for thrombolysis. Methods Consecutive patients assessed via telemedicine from April 2013 to June 2018. Clinical outcomes were measured, and decision-making compared using theoretical models for reperfusion therapy applied without mCT guidance. Symptomatic intracranial hemorrhage (sICH) was assessed according to Safe Implementation of Treatments in Stroke Thrombolysis Registry criteria. Results A total of 334 patients were assessed, 240 received mCT, 58 were thrombolysed (24.2%). The mean age of thrombolysed patients was 70 years, median baseline National Institutes of Health Stroke Scale was 10 (IQR 7-18) and 23 (39.7%) had a large vessel occlusion. 1.7% had sICH and 3.5% parenchymal hematoma. Three months poststroke, 55% were independent, compared with 70% in the non-thrombolysed group. Conclusion Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH.
引用
收藏
页码:367 / 373
页数:7
相关论文
共 25 条
[1]   Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging [J].
Albers, G. W. ;
Marks, M. P. ;
Kemp, S. ;
Christensen, S. ;
Tsai, J. P. ;
Ortega-Gutierrez, S. ;
McTaggart, R. A. ;
Torbey, M. T. ;
Kim-Tenser, M. ;
Leslie-Mazwi, T. ;
Sarraj, A. ;
Kasner, S. E. ;
Ansari, S. A. ;
Yeatts, S. D. ;
Hamilton, S. ;
Mlynash, M. ;
Heit, J. J. ;
Zaharchuk, G. ;
Kim, S. ;
Carrozzella, J. ;
Palesch, Y. Y. ;
Demchuk, A. M. ;
Bammer, R. ;
Lavori, P. W. ;
Broderick, J. P. ;
Lansberg, M. G. .
NEW ENGLAND JOURNAL OF MEDICINE, 2018, 378 (08) :708-718
[2]  
[Anonymous], 2017, AUSTR CLIN GUID STRO
[3]   Comparison of tissue plasminogen activator administration management between telestroke network hospitals and academic stroke centers -: The Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany [J].
Audebert, Heinrich J. ;
Kukla, Christian ;
Vatankhah, Bijan ;
Gotzler, Berthold ;
Schenkel, Johannes ;
Hofer, Stephan ;
Fuerst, Andrea ;
Haberl, Roman L. .
STROKE, 2006, 37 (07) :1822-1827
[4]   Too Good to Treat? Ischemic Stroke Patients with Small Computed Tomography Perfusion Lesions May Not Benefit from Thrombolysis [J].
Bivard, Andrew ;
Lou, Min ;
Levi, Christopher R. ;
Krishnamurthy, Venkatesh ;
Cheng, Xin ;
Aviv, Richard I. ;
McElduff, Patrick ;
Lin, Longting ;
Kleinig, Tim ;
O'Brien, Billy ;
Butcher, Kenneth ;
Zhang Jingfen ;
Jannes, Jim ;
Dong, Qiang ;
Parsons, Mark W. .
ANNALS OF NEUROLOGY, 2016, 80 (02) :286-293
[5]   Perfusion computed tomography to assist decision making for stroke thrombolysis [J].
Bivard, Andrew ;
Levi, Christopher ;
Krishnamurthy, Venkatesh ;
McElduff, Patrick ;
Miteff, Ferdi ;
Spratt, Neil J. ;
Bateman, Grant ;
Donnan, Geoffrey ;
Davis, Stephen ;
Parsons, Mark .
BRAIN, 2015, 138 :1919-1931
[6]   Perfusion CT in Acute Stroke: A Comprehensive Analysis of Infarct and Penumbra [J].
Bivard, Andrew ;
Levi, Christopher ;
Spratt, Neil ;
Parsons, Mark .
RADIOLOGY, 2013, 267 (02) :543-550
[7]   Extending thrombolysis to 4.5-9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data [J].
Campbell, Bruce C., V ;
Ma, Henry ;
Ringleb, Peter A. ;
Parsons, Mark W. ;
Churilov, Leonid ;
Bendszus, Martin ;
Levi, Christopher R. ;
Hsu, Chung ;
Kleinig, Timothy J. ;
Fatar, Marc ;
Leys, Didier ;
Molina, Carlos ;
Wijeratne, Tissa ;
Curtze, Sami ;
Dewey, Helen M. ;
Barber, P. Alan ;
Butcher, Kenneth S. ;
De Silva, Deidre A. ;
Bladin, Christopher F. ;
Yassi, Nawaf ;
Pfaff, Johannes A. R. ;
Sharma, Gagan ;
Bivard, Andrew ;
Desmond, Patricia M. ;
Schwab, Stefan ;
Schellinger, Peter D. ;
Yan, Bernard ;
Mitchell, Peter J. ;
Serena, Joaquin ;
Toni, Danilo ;
Thijs, Vincent ;
Hacke, Werner ;
Davis, Stephen M. ;
Donnan, Geoffrey A. .
LANCET, 2019, 394 (10193) :139-147
[8]   Comparison of Computed Tomography Perfusion and Magnetic Resonance Imaging Perfusion-Diffusion Mismatch in Ischemic Stroke [J].
Campbell, Bruce C. V. ;
Christensen, Soren ;
Levi, Christopher R. ;
Desmond, Patricia M. ;
Donnan, Geoffrey A. ;
Davis, Stephen M. ;
Parsons, Mark W. .
STROKE, 2012, 43 (10) :2648-2653
[9]   Stroke Team Remote Evaluation Using a Digital Observation Camera in Arizona The Initial Mayo Clinic Experience Trial [J].
Demaerschalk, Bart M. ;
Bobrow, Bentley J. ;
Raman, Rema ;
Kiernan, Terri-Ellen J. ;
Aguilar, Maria I. ;
Ingall, Timothy J. ;
Dodick, David W. ;
Ward, Michael P. ;
Richemont, Phillip C. ;
Brazdys, Karina ;
Koch, Tiffany C. ;
Miley, Madeline L. ;
Snyder, Charlene R. Hoffman ;
Corday, Doren A. ;
Meyer, Brett C. .
STROKE, 2010, 41 (06) :1251-1258
[10]   The establishment of a telestroke service using multimodal CT imaging decision assistance: "Turning on the fog lights" [J].
Demeestere, Jelle ;
Sewell, Claire ;
Rudd, Jennifer ;
Ang, Timothy ;
Jordan, Louise ;
Wills, James ;
Garcia-Esperon, Carlos ;
Miteff, Ferdinand ;
Krishnamurthy, Venkatesh ;
Spratt, Neil ;
Lin, Longting ;
Bivard, Andrew ;
Parsons, Mark ;
Levi, Christopher .
JOURNAL OF CLINICAL NEUROSCIENCE, 2017, 37 :1-5