Endovenous thrombolysis in a district hospital using the telestroke system

Intruoduction. In January 2007, a telestroke system was established between a community hospital lacking a neurologist on call and a stroke centre 70 km away for acute stroke care. Aim. To study the impact of a telemedicine system for acute stroke care in a community hospital and the security of thrombolytic treatment. Patients and methods. Observational study of acute stroke patients attended in the emergency room in a community hospital between 2007 and 2010. Results. 662 acute stroke patients were attended. 133 'tele-consults' were done (37.6% ischemic stroke established). 39 patients (29.3%) were transferred to the stroke centre, 5 (12.8%) of them were considered unnecessary. 46 patients received thrombolytic treatment in the community hospital. The average time door-needle was 53.4 ± 38.2 minutes. 60.9% patients were treated during the first three hours since symptoms onset, and 100% in less than 4.5 hours. 9 patients received intra-arterial treatment. 4 patients (8.69%) presented hemorrhagic transformation 2 (4.3%) were symptomatic. 71.7% presented neurological improvement in 24 hours. 53.65% were functionally independent (mRS equal or less than 2) to three months. The mortality was 10.86%. Conclusions. Tele-stroke allows a specialized attention for acute stroke in a community hospital, to administer thrombolytic treatment and could be an indispensable tool for select patient to transfer to the stroke centre for intra-arterial rescue procedures. © 2011 Revista de Neurología.