Department of Neurology, Medical University of South Carolina , Charleston, South Carolina.
Telemed J E Health. 2017 Aug;23(8):674-677. doi: 10.1089/tmj.2016.0229. Epub 2017 Feb 7.
Patients in rural communities lack access to acute stroke therapies. Rapid administration of lytic therapy increases the likelihood of favorable functional outcome in acute ischemic stroke (AIS). At the Medical University of South Carolina (MUSC), we implemented a Web-based telestroke program that allows patients presenting with AIS at a rural hospital to receive expert stroke consultation within minutes. This increases their chances of receiving lytic therapy, and therefore increases the likelihood of good functional outcome.
Our study aims to provide an update on how our telestroke program had developed and the rate and safety of intravenous (IV) alteplase administration through telestroke.
Data were collected on all patients evaluated through the MUSC Telestroke program from May 2008 through April 2014. Collected data included National Institutes of Health Stroke Scale (NIHSS) on presentation, number of IV alteplase administrations, number of patients transferred to MUSC, number of mechanical thrombectomies performed on transferred patients, rate of symptomatic intracerebral hemorrhages (sICHs), and discharge location.
A total of 7,694 consults were performed during the study period. Of them 3,795 (49.2%) patients were diagnosed with ischemic stroke, of those 1,324 (34.8%) received IV alteplase. A total of 1,282 patients were transferred to MUSC for further care. From November 2014 to April 2016, 56 patients received mechanical thrombectomy. sICH occurred in 33 patients who received alteplase, and in 5 patients receiving a combination of IV and intraarterial thrombolysis. Over the study period, the number of participating sites increased from 6 to 19 sites. The percentage of transfers to MUSC decreased from 36% to 14%.
Our study shows that our telestroke program had evolved over time to involve more sites throughout the state of South Carolina. Post-IV alteplase sICH was low and within the expected range.
农村社区的患者无法获得急性脑卒中治疗。迅速给予溶栓治疗可增加急性缺血性脑卒中（AIS）患者获得良好功能结局的可能性。在南卡罗来纳医科大学（MUSC），我们实施了一个基于网络的远程脑卒中项目，使在农村医院就诊的 AIS 患者能够在几分钟内获得脑卒中专家的咨询。这增加了他们接受溶栓治疗的机会，从而提高了获得良好功能结局的可能性。
本研究旨在介绍我们的远程脑卒中项目的发展情况，以及通过远程脑卒中项目给予静脉内（IV）阿替普酶治疗的速度和安全性。
收集 2008 年 5 月至 2014 年 4 月期间通过 MUSC 远程脑卒中项目评估的所有患者的数据。收集的数据包括发病时的国立卫生研究院脑卒中量表（NIHSS）评分、IV 阿替普酶给药次数、转至 MUSC 的患者数量、转至 MUSC 的患者中实施机械血栓切除术的数量、症状性颅内出血（sICH）的发生率和出院地点。
在研究期间共进行了 7694 次咨询。其中 3795 例（49.2%）患者被诊断为缺血性脑卒中，其中 1324 例（34.8%）接受了 IV 阿替普酶治疗。共有 1282 例患者被转至 MUSC 接受进一步治疗。从 2014 年 11 月至 2016 年 4 月，56 例患者接受了机械血栓切除术。接受阿替普酶治疗的 33 例患者和接受 IV 和动脉内溶栓联合治疗的 5 例患者发生了 sICH。在研究期间，参与的地点从 6 个增加到 19 个。转至 MUSC 的比例从 36%降至 14%。
本研究表明，我们的远程脑卒中项目随着时间的推移不断发展，参与的南卡罗来纳州的地点也越来越多。IV 阿替普酶治疗后 sICH 的发生率低且在预期范围内。
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