BACKGROUND AND PURPOSE: Telestroke networks support screening for patients with emergent large-vessel occlusions who are eligible for endovascular thrombectomy. Ideal triage processes within telestroke networks remain uncertain. We characterize the impact of implementing a routine spoke hospital CTA protocol in our integrated telestroke network on transfer and thrombectomy patterns. MATERIALS AND METHODS: A protocol-driven CTA process was introduced at 22 spoke hospitals in November 2017. We retrospectively identified prospectively collected patients who presented to a spoke hospital with National Institutes of Health Stroke Scale scores ≥6 between March 1, 2016 and March 1, 2017 (pre-CTA), and March 1, 2018 and March 1, 2019 (post-CTA). We describe the demographics, CTA utilization, spoke hospital retention rates, emergent large-vessel occlusion identification, and rates of endovascular thrombectomy. RESULTS: There were 167 patients pre-CTA and 207 post-CTA. The rate of CTA at spoke hospitals increased from 15% to 70% (P < .001). Despite increased endovascular thrombectomy screening in the extended window, the overall rates of transfer out of spoke hospitals remained similar (56% versus 54%; P = .83). There was a nonsignificant increase in transfers to our hub hospital for endovascular thrombectomy (26% versus 35%; P = .12), but patients transferred >4.5 hours from last known well increased nearly 5-fold (7% versus 34%; P < .001). The rate of endovascular thrombectomy performed on patients transferred for possible endovascular thrombectomy more than doubled (22% versus 47%; P = .011). CONCLUSIONS: Implementation of CTA at spoke hospitals in our telestroke network was feasible and improved the efficiency of stroke triage. Rates of patients retained at spoke hospitals remained stable despite higher numbers of patients screened. Emergent large-vessel occlusion confirmation at the spoke hospital lead to a more than 2-fold increase in thrombectomy rates among transferred patients at the hub.
BACKGROUND AND PURPOSE: Telestroke networks support screening for patients with emergent large-vessel occlusions who are eligible for endovascular thrombectomy. Ideal triage processes within telestroke networks remain uncertain. We characterize the impact of implementing a routine spoke hospital CTA protocol in our integrated telestroke network on transfer and thrombectomy patterns. MATERIALS AND METHODS: A protocol-driven CTA process was introduced at 22 spoke hospitals in November 2017. We retrospectively identified prospectively collected patients who presented to a spoke hospital with National Institutes of Health Stroke Scale scores ≥6 between March 1, 2016 and March 1, 2017 (pre-CTA), and March 1, 2018 and March 1, 2019 (post-CTA). We describe the demographics, CTA utilization, spoke hospital retention rates, emergent large-vessel occlusion identification, and rates of endovascular thrombectomy. RESULTS: There were 167 patients pre-CTA and 207 post-CTA. The rate of CTA at spoke hospitals increased from 15% to 70% (P < .001). Despite increased endovascular thrombectomy screening in the extended window, the overall rates of transfer out of spoke hospitals remained similar (56% versus 54%; P = .83). There was a nonsignificant increase in transfers to our hub hospital for endovascular thrombectomy (26% versus 35%; P = .12), but patients transferred >4.5 hours from last known well increased nearly 5-fold (7% versus 34%; P < .001). The rate of endovascular thrombectomy performed on patients transferred for possible endovascular thrombectomy more than doubled (22% versus 47%; P = .011). CONCLUSIONS: Implementation of CTA at spoke hospitals in our telestroke network was feasible and improved the efficiency of stroke triage. Rates of patients retained at spoke hospitals remained stable despite higher numbers of patients screened. Emergent large-vessel occlusion confirmation at the spoke hospital lead to a more than 2-fold increase in thrombectomy rates among transferred patients at the hub.
Authors: Radoslav I Raychev; Dana Stradling; Nirav Patel; Joey R Gee; David A Lombardi; Johnson L Moon; David M Brown; Mayank Pathak; Wengui Yu; Samuel J Stratton; Steven C Cramer Journal: Stroke Date: 2018-04-06 Impact factor: 7.914
Authors: Brian S Katz; Opeolu Adeoye; Heidi Sucharew; Joseph P Broderick; Jason McMullan; Pooja Khatri; Michael Widener; Kathleen S Alwell; Charles J Moomaw; Brett M Kissela; Matthew L Flaherty; Daniel Woo; Simona Ferioli; Jason Mackey; Sharyl Martini; Felipe De Los Rios la Rosa; Dawn O Kleindorfer Journal: Stroke Date: 2017-07-12 Impact factor: 7.914
Authors: Gregory W Albers; Michael P Marks; Stephanie Kemp; Soren Christensen; Jenny P Tsai; Santiago Ortega-Gutierrez; Ryan A McTaggart; Michel T Torbey; May Kim-Tenser; Thabele Leslie-Mazwi; Amrou Sarraj; Scott E Kasner; Sameer A Ansari; Sharon D Yeatts; Scott Hamilton; Michael Mlynash; Jeremy J Heit; Greg Zaharchuk; Sun Kim; Janice Carrozzella; Yuko Y Palesch; Andrew M Demchuk; Roland Bammer; Philip W Lavori; Joseph P Broderick; Maarten G Lansberg Journal: N Engl J Med Date: 2018-01-24 Impact factor: 91.245
Authors: Martin A Reznek; Evangelia Murray; Marguerite N Youngren; Natassia T Durham; Sean S Michael Journal: Stroke Date: 2016-11-17 Impact factor: 7.914
Authors: Andrew M Southerland; Karen C Johnston; Carlos A Molina; Magdy H Selim; Noreen Kamal; Mayank Goyal Journal: Stroke Date: 2016-02-19 Impact factor: 7.914
Authors: Beatriz Mendez; Manuel Requena; Ana Aires; Nuno Martins; Sandra Boned; Marta Rubiera; Alejandro Tomasello; Pilar Coscojuela; Marián Muchada; David Rodríguez-Luna; Noelia Rodríguez-Villatoro; Jesús Juega; Jorge Pagola; Carlos A Molina; Marc Ribó Journal: Stroke Date: 2018-11 Impact factor: 7.914
Authors: Michael T Froehler; Jeffrey L Saver; Osama O Zaidat; Reza Jahan; Mohammad Ali Aziz-Sultan; Richard P Klucznik; Diogo C Haussen; Frank R Hellinger; Dileep R Yavagal; Tom L Yao; David S Liebeskind; Ashutosh P Jadhav; Rishi Gupta; Ameer E Hassan; Coleman O Martin; Hormozd Bozorgchami; Ritesh Kaushal; Raul G Nogueira; Ravi H Gandhi; Eric C Peterson; Shervin R Dashti; Curtis A Given; Brijesh P Mehta; Vivek Deshmukh; Sidney Starkman; Italo Linfante; Scott H McPherson; Peter Kvamme; Thomas J Grobelny; Muhammad S Hussain; Ike Thacker; Nirav Vora; Peng Roc Chen; Stephen J Monteith; Robert D Ecker; Clemens M Schirmer; Eric Sauvageau; Alex Abou-Chebl; Colin P Derdeyn; Lucian Maidan; Aamir Badruddin; Adnan H Siddiqui; Travis M Dumont; Abdulnasser Alhajeri; M Asif Taqi; Khaled Asi; Jeffrey Carpenter; Alan Boulos; Gaurav Jindal; Ajit S Puri; Rohan Chitale; Eric M Deshaies; David H Robinson; David F Kallmes; Blaise W Baxter; Mouhammad A Jumaa; Peter Sunenshine; Aniel Majjhoo; Joey D English; Shuichi Suzuki; Richard D Fessler; Josser E Delgado Almandoz; Jerry C Martin; Nils H Mueller-Kronast Journal: Circulation Date: 2017-09-24 Impact factor: 29.690
Authors: Robert W Regenhardt; Alvin S Das; Christopher J Stapleton; Ronil V Chandra; James D Rabinov; Aman B Patel; Joshua A Hirsch; Thabele M Leslie-Mazwi Journal: Front Neurol Date: 2017-07-03 Impact factor: 4.003
Authors: Robert W Regenhardt; Amine Awad; Andrew W Kraft; Joseph A Rosenthal; Adam A Dmytriw; Justin E Vranic; Anna K Bonkhoff; Martin Bretzner; Mark R Etherton; Joshua A Hirsch; James D Rabinov; Aneesh B Singhal; Natalia S Rost; Christopher J Stapleton; Thabele M Leslie-Mazwi; Aman B Patel Journal: Stroke Vasc Interv Neurol Date: 2022-05-20
Authors: Robert W Regenhardt; Anna K Bonkhoff; Martin Bretzner; Mark R Etherton; Alvin S Das; Sungmin Hong; Naif M Alotaibi; Justin E Vranic; Adam A Dmytriw; Christopher J Stapleton; Aman B Patel; Thabele M Leslie-Mazwi; Natalia S Rost Journal: Neurology Date: 2022-01-31 Impact factor: 9.910
Authors: Robert W Regenhardt; R Gilberto González; Julian He; Michael H Lev; Aneesh B Singhal Journal: Radiology Date: 2021-11-02 Impact factor: 11.105
Authors: Robert W Regenhardt; Ashby C Turner; Joshua A Hirsch; Michael J Young; Naif M Alotaibi; Christopher J Stapleton; Aman B Patel; Thabele M Leslie-Mazwi; Natalia S Rost; Mark R Etherton Journal: J Neurol Date: 2021-05-29 Impact factor: 4.849