Facilitated Roundtable Discussion
CS2-13 - Symptomatic Intracerebral Hemorrhage Related to tPA Administered over Tele Stroke Within 4.5-hour Window
Tuesday, May 1
11:35 AM - 12:00 PM
Location: Education Zone, Booth 2416, Zone 3
Introduction: Intravenous alteplase (tPA) remains the cornerstone medical treatment for acute ischemic stroke. Standard of care guidelines have expanded, from the prior guideline of 3 hours, to allow tPA administration within 4.5 hours of stroke onset. Symptomatic intracerebral hemorrhage (sICH) is one of the most serious complications of stroke treatment. The establishment of telestroke technology has allowed patients presenting to hospitals that lack expert stroke care to be evaluated and receive tPA. The safety of tPA administered through telestroke has been evaluated only when tPA is given within the 3-hour window of last known normal.
Methods: A retrospective analysis on the prospectively collected database for all patients that received tPA at the Medical University of South Carolina Comprehensive Stroke Center (MUSC) (hub), as well as the MUSC telestroke network partner hospitals (spokes) was performed. Collected data included demographics, baseline characteristics, time from last known well to tPA administration, door-to-needle times, and symptomatic intracerebral hemorrhage rates. Logistic regression was used to examine the odds of a symptomatic intracerebral hemorrhage (sICH) in patients at spoke sites compared to the hub controlling for patient demographics and stroke severity.
Results: A total of 816 patients were identified. The sample includes 564 patients administered tPA via telestroke services at the spoke sites and 252 at the hub. Median NIHSS was significantly higher among patients treated at the hub (9 vs 8, P=0.022), otherwise baseline characteristics were similar in both treatment groups. The door to needle times improved overtime in both groups. By 2016 both the spoke and the hub averaged door-to-needle (DTN) times within the 60-minute guideline. However, DTN times remain lower in the hub site (42 minutes) compared to the spokes (59 minutes). Symptomatic intracerebral hemorrhage (sICH) occurred in 26 (4.61%) in the spoke group and 10 (3.97%) in the hub group (P=0.68). Logistic regression results found no significant difference in the odds of sICH if tPA is given in a spoke site and no differences in adverse outcomes with tPA administration 0-179 minutes versus 180-270 minutes from last known normal time (p=0.308).
Our study shows that intravenous tPA when administered at spoke hospitals through telestroke consultations within the 4.5-hour window does not increase the odds of sICH compared to administration at hub hospitals.
- Describe the statewide telestroke network.
- Compare patient process measures and outcomes in those treated via the telestroke network and those receiving traditional care accessed through the hub emergency department.
- Evaluate the safety of tPA when administered thorough telestroke within a 4.5-hour window.