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

Carlos Garcia-Esperon; Frode Soderhjelm Dinkelspiel; Ferdi Miteff; Shyam Gangadharan; Tom Wellings; Bill O´Brien; James Evans; Tom Lillicrap; Jelle Demeestere; Andrew Bivard; Mark Parsons; Chris Levi; Neil James Spratt; Rachel Peake; James Hughes; Lisa Dark; Nick Ryan; Matt Shepherd; Osama Ali; James Wills; Fiona Minett; Jaclyn Birnie; Amanda Buzio; Iain Bruce; Alan Tankel; Kim Parrey; Matthew Kinchington; Elizabeth Pepper; Andre Loiselle; Sophie Waller; Alvin Chew; Michelle Russell; Angela Royan; Brett Roworth; Northern NSW Telestroke investigators for the Northern NSW Telestroke investigators

doi:10.1111/cns.13224

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

Carlos Garcia-Esperon, Frode Soderhjelm Dinkelspiel, Ferdi Miteff, Shyam Gangadharan, Tom Wellings, Bill O´Brien, James Evans, Tom Lillicrap, Jelle Demeestere, Andrew Bivard, Mark Parsons, Chris Levi, Neil James Spratt, Rachel Peake, James Hughes, Lisa Dark, Nick Ryan, Matt Shepherd, Osama Ali, James WillsFiona Minett, Jaclyn Birnie, Amanda Buzio, Iain Bruce, Alan Tankel, Kim Parrey, Matthew Kinchington, Elizabeth Pepper, Andre Loiselle, Sophie Waller, Alvin Chew, Michelle Russell, Angela Royan, Brett Roworth, Northern NSW Telestroke investigators for the Northern NSW Telestroke investigators

Western Sydney University

Research output: Contribution to journal › Article › peer-review

Abstract

Aims: Penumbral selection is best-evidence practice for thrombectomy in the 6-24ÃÂ 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 70ÃÂ 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. ÃÂ© 2019 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

Original language	English
Pages (from-to)	367-373
Number of pages	7
Journal	CNS Neuroscience and Therapeutics
Volume	26
Issue number	3
DOIs	https://doi.org/10.1111/cns.13224
Publication status	Published - 2020

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This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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10.1111/cns.13224

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Garcia-Esperon, C., Dinkelspiel, F. S., Miteff, F., Gangadharan, S., Wellings, T., O´Brien, B., Evans, J., Lillicrap, T., Demeestere, J., Bivard, A., Parsons, M., Levi, C., Spratt, N. J., Peake, R., Hughes, J., Dark, L., Ryan, N., Shepherd, M., Ali, O., ... for the Northern NSW Telestroke investigators, N. NSW. T. I. (2020). Implementation of multimodal computed tomography in a telestroke network : five-year experience. CNS Neuroscience and Therapeutics, 26(3), 367-373. https://doi.org/10.1111/cns.13224

@article{00815634b6524e18a05602a483946100,

title = "Implementation of multimodal computed tomography in a telestroke network : five-year experience",

abstract = "Aims: Penumbral selection is best-evidence practice for thrombectomy in the 6-24{\~A}{\^A} 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{\~A}{\^A} 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. {\~A}{\^A}{\textcopyright} 2019 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.",

author = "Carlos Garcia-Esperon and Dinkelspiel, {Frode Soderhjelm} and Ferdi Miteff and Shyam Gangadharan and Tom Wellings and Bill O´Brien and James Evans and Tom Lillicrap and Jelle Demeestere and Andrew Bivard and Mark Parsons and Chris Levi and Spratt, {Neil James} and Rachel Peake and James Hughes and Lisa Dark and Nick Ryan and Matt Shepherd and Osama Ali and James Wills and Fiona Minett and Jaclyn Birnie and Amanda Buzio and Iain Bruce and Alan Tankel and Kim Parrey and Matthew Kinchington and Elizabeth Pepper and Andre Loiselle and Sophie Waller and Alvin Chew and Michelle Russell and Angela Royan and Brett Roworth and {for the Northern NSW Telestroke investigators}, {Northern NSW Telestroke investigators}",

year = "2020",

doi = "10.1111/cns.13224",

language = "English",

volume = "26",

pages = "367--373",

journal = "CNS Neuroscience and Therapeutics",

issn = "1755-5949",

publisher = "Wiley-Blackwell Publishing",

number = "3",

}

Garcia-Esperon, C, Dinkelspiel, FS, Miteff, F, Gangadharan, S, Wellings, T, O´Brien, B, Evans, J, Lillicrap, T, Demeestere, J, Bivard, A, Parsons, M, Levi, C, Spratt, NJ, Peake, R, Hughes, J, Dark, L, Ryan, N, Shepherd, M, Ali, O, Wills, J, Minett, F, Birnie, J, Buzio, A, Bruce, I, Tankel, A, Parrey, K, Kinchington, M, Pepper, E, Loiselle, A, Waller, S, Chew, A, Russell, M, Royan, A, Roworth, B & for the Northern NSW Telestroke investigators, NNSWTI 2020, 'Implementation of multimodal computed tomography in a telestroke network : five-year experience', CNS Neuroscience and Therapeutics, vol. 26, no. 3, pp. 367-373. https://doi.org/10.1111/cns.13224

TY - JOUR

T1 - Implementation of multimodal computed tomography in a telestroke network : five-year experience

AU - Garcia-Esperon, Carlos

AU - Dinkelspiel, Frode Soderhjelm

AU - Miteff, Ferdi

AU - Gangadharan, Shyam

AU - Wellings, Tom

AU - O´Brien, Bill

AU - Evans, James

AU - Lillicrap, Tom

AU - Demeestere, Jelle

AU - Bivard, Andrew

AU - Parsons, Mark

AU - Levi, Chris

AU - Spratt, Neil James

AU - Peake, Rachel

AU - Hughes, James

AU - Dark, Lisa

AU - Ryan, Nick

AU - Shepherd, Matt

AU - Ali, Osama

AU - Wills, James

AU - Minett, Fiona

AU - Birnie, Jaclyn

AU - Buzio, Amanda

AU - Bruce, Iain

AU - Tankel, Alan

AU - Parrey, Kim

AU - Kinchington, Matthew

AU - Pepper, Elizabeth

AU - Loiselle, Andre

AU - Waller, Sophie

AU - Chew, Alvin

AU - Russell, Michelle

AU - Royan, Angela

AU - Roworth, Brett

AU - for the Northern NSW Telestroke investigators, Northern NSW Telestroke investigators

PY - 2020

Y1 - 2020

N2 - Aims: Penumbral selection is best-evidence practice for thrombectomy in the 6-24ÃÂ 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 70ÃÂ 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. ÃÂ© 2019 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

AB - Aims: Penumbral selection is best-evidence practice for thrombectomy in the 6-24ÃÂ 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 70ÃÂ 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. ÃÂ© 2019 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.

UR - https://hdl.handle.net/1959.7/uws:64263

U2 - 10.1111/cns.13224

DO - 10.1111/cns.13224

M3 - Article

SN - 1755-5949

SN - 1755-5930

VL - 26

SP - 367

EP - 373

JO - CNS Neuroscience and Therapeutics

JF - CNS Neuroscience and Therapeutics

IS - 3

ER -

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

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