Background: The Comprehensive Stroke Center at Wake Forest Baptist Medical Center in Winston-Salem, N.C. implemented a telestroke network system in January of 2010 to provide 24/7 access to one of their board certified vascular neurologists. There are presently fourteen hospitals in the network with over 1900 consults and a tPA administration rate of 42%.
In early 2015, positive results from four stroke interventional trials showed that recanalization rates were much higher after stent retrieval compared with tPA alone. It was shown that these devices can safely and effectively remove a blood clot that is causing a stroke, with improved clinical outcomes over IV tPA alone. Wake Forest Baptist has made the commitment to expand the use of intraarterial therapy to give every telestroke patient with a large vessel occlusion an opportunity to experience the outstanding clinical outcomes that have been seen in stroke patients treated at their medical center.
The following guidelines were developed to assist the network physician in determining when to consider interventional treatment:
- The time from onset is less than 6 hrs. (up to 12 hrs. in a suspected basilar artery stroke)
- A NIHSS score equal to or greater than 10 (indicating large vessel occlusion)
Method: Education was provided regarding the new interventional treatment guidelines and for quick reference, the protocol was placed on the screen of the telestroke robot/cart in each of the network hospitals and a cell phone number was provided that gave 24/7 access to communicate with the neurointerventionalist on call. A retrospective study was performed to determine if there had been an increase in patient transfers for an interventional procedure.
Results: In FY'14, 14 of 139 patients (10%) transferred received an IR procedure and in FY'15, 26 of 146 (17%) patients received an IR procedure. An increase of 7% was identified in telestroke patients that were transferred and underwent an interventional treatment. A combination of providing guidelines regarding when to consider interventional treatment as well as 24/7 access to a neurointerventionalist has significantly increased number of telestroke patients receiving interventional treatment.