1 Department of Neurology, Medical University of South Carolina , Charleston, South Carolina.
2 Department of Healthcare Leadership and Management, College of Health Professions, Medical University of South Carolina , Charleston, South Carolina.
Telemed J E Health. 2018 Oct;24(10):749-752. doi: 10.1089/tmj.2017.0248. Epub 2018 Jan 25.
Intravenous tissue plasminogen activator (tPA) remains the cornerstone medical treatment for acute ischemic stroke. The establishment of telestroke technology has allowed patients presenting to hospitals that lack expert stroke care to be evaluated and receive tPA. The safety of tPA administered through telestroke has been evaluated only when tPA is given within the 3-h window of last known normal. The purpose of this study is to evaluate the safety of tPA when administered through telestroke within a 4.5-h window.
A retrospective analysis on the prospectively collected database for all patients who received tPA at the Medical University of South Carolina Comprehensive Stroke Center (MUSC) (hub), as well as the MUSC telestroke network partner hospitals (spokes), was performed. Collected data included demographics, baseline characteristics, time from last known well to tPA administration, and symptomatic intracerebral hemorrhage (sICH) rates. Logistic regression was used to examine the odds of a sICH in patients at spoke sites compared with the hub controlling for patient stroke severity, gender, age, and race.
A total of 830 patients were identified. Median National Institute of Health Stroke Scale was significantly higher among patients treated at the hub (9 vs. 8, p = 0.013), and the hub treated a higher percentage of nonwhite patients (p = 0.039). sICH occurred in 27 (4.8%) in the spoke group and 10 (3.8%) in the hub group (p = 0.523). Logistic regression results found no significant difference in the odds of sICH if tPA is given in a spoke site.
Our study shows similar rates of sICH when intravenous tPA is administered at spokes through telestroke network compared with the hub.
静脉注射组织型纤溶酶原激活剂（tPA）仍然是急性缺血性脑卒中的基础治疗方法。远程卒中技术的建立使得在缺乏专业卒中治疗的医院就诊的患者能够接受评估并接受 tPA。仅在最后一次已知正常时间 3 小时窗口内给予 tPA 时，才对通过远程卒中给予 tPA 的安全性进行了评估。本研究的目的是评估在 4.5 小时窗口内通过远程卒中给予 tPA 的安全性。
对所有在南卡罗来纳医科大学综合卒中中心（MUSC）（中心）以及 MUSC 远程卒中网络合作医院（辐条）接受 tPA 治疗的患者前瞻性收集的数据库进行回顾性分析。收集的数据包括人口统计学、基线特征、从最后一次已知正常到 tPA 给药的时间以及症状性颅内出血（sICH）的发生率。使用逻辑回归检查在辐条地点与中心相比患者发生 sICH 的几率，同时控制患者的卒中严重程度、性别、年龄和种族。
共确定了 830 名患者。接受中心治疗的患者的国家卫生研究院卒中量表中位数明显更高（9 与 8，p=0.013），并且中心治疗的非白人患者比例更高（p=0.039）。在辐条组中，sICH 发生了 27 例（4.8%），在中心组中发生了 10 例（3.8%）（p=0.523）。逻辑回归结果发现，如果在辐条地点给予 tPA，sICH 的几率没有显著差异。
我们的研究表明，通过远程卒中网络在辐条地点给予静脉内 tPA 的 sICH 发生率与中心相似。
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