Highlights
- •We didn’t observe any statistical association between SBP variation and long term clinical outcome.
- •We didn’t observe association between SBP during the acute phase and clinical outcome.
- •We advocate lowering SBP to <185 mmHg to increase IVrt-PA eligibility rates.
- •We recruited new stroke patients eligible for MT through the TS network.
- •38% of MT patients had an mRS ≤ 2 on their last follow-up visit.
- •Fulfilling new strategies and approaches to stroke patients leads to better results.
Abstract
Background
Telemedicine rapidly connects patients, with acute ischemic stroke symptoms, with
neurovascular specialists for assessment to reduce chemical thrombolysis delivery
times. Management of AIS includes maintaining target systolic blood pressures (SBP).
In this retrospective study, we assess the efficacy of the telestroke (TS) system
at a primary stroke center and the prognostic value of SBP throughout the transportation
process.
Methods
Patients presenting with acute-onset neurological symptoms to the TS hospitals network,
over a 5-year period, were assessed. Those with a confirmed diagnosis of AIS were
included. We examined demographics, presenting-NIHSS, last SBP before transfer from
the network hospital and continuous BP during transport, stroke risk factors, hospital-course,
door-to-needle (DTN) time, treatments, and modified Rankin Scale(mRS). Multivariate
analysis was conducted to evaluate the prognostic value of SBP on stroke outcome.
Results
Of 2,928 patients identified, 1,353 were diagnosed with AIS. Mean age was 66.6 years
(SD = 15.4), 47.6% female. Most cases affected the MCA(44.5%). Mean presenting-NIHSS
was 8.67(SD = 8.38) and mean SBP was 148 mmHg(SD = 25.39). 73.2% treated using a standard
protocol, 23.7% given IVrt-PA, and 6.8% received mechanical thrombectomy(MT). Mean
DTN was 96 min(SD = 46; 27.3% <60 min). Age, presenting-NIHSS and pre-existing hypertension
were associated with higher mortality and/or higher mRS. SBP was not associated with
higher mortality and morbidity.
Conclusions
This study displays better clinical outcomes at latest follow-up when compared to
current international TS studies. SBP during transportation to the hub hospital did
not prove to be a useful prognostic metric. However, future studies should address
the limitations of this study to confirm these findings.
Keywords
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Article info
Publication history
Published online: January 16, 2019
Accepted:
January 3,
2019
Received:
August 28,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
