1. Cerebrovasc Dis. 2018 Aug 22;46(1-2):66-71. doi: 10.1159/000492124.

[Epub ahead
of print]

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital

Transfers.

López-Cancio E(1), Ribó M(2), Cardona P(3), Serena J(4), Purroy F(5), Palomeras
E(6), Aragonès JM(7), Cocho D(8), Garcés M(9), Puiggròs E(10), Soteras I(11),
Cabanelas A(12), Villagrasa D(13), Catena E(14), Sanjurjo E(15), López Claverol
N(16), Carrión D(17), López M(18), Abilleira S(19)(20), Dávalos A(21), Pérez de
la Ossa N(21); Catalan Stroke Code and Reperfusion Consortium (Cat-SCR).

Author information:
(1)Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain.
(2)Hospital Universitai Vall d'Hebrón, Barcelona, Spain.
(3)Hospital Universitari Bellvitge, Barcelona, Spain.
(4)Hospital Unversitari Josep Trueta, , Spain, Girona, Spain.
(5)Hospital Universitari Arnau de Vilanova, IRBLleida. UdL, Lleida, Spain.
(6)Hospital de Mataró, Barcelona, Spain.
(7)Consorci Hospitalari de Vic, Barcelona, Spain.
(8)Hospital General de Granollers, Barcelona, Spain.
(9)Hospital Verge de la Cinta, Tarragona, Spain.
(10)Hospital Sant Camil, Sant Pere de Ribes, Barcelona, Spain.
(11)Hospital de la Cerdanya, Girona, Spain.
(12)Hospital Palamós, Girona, Spain.
(13)Hospital d'Igualada, Barcelona, Spain.
(14)Hospital Comarcal Alt Penedès, Barcelona, Spain.
(15)Hospital Comarcal del Pallars, Lleida, Spain.
(16)Fundació Sant Hospital la Seu d'Urgell, Lleida, Spain.
(17)Hospital Mora d'Ebre, Tarragona, Spain.
(18)Hospital Figueres, Girona, Spain.
(19)Stroke Program, Agency for Health Quality and Assessment of Catalonia,
Barcelona, Spain.
(20)CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain.
(21)Hospital Germans Trias i Pujol, Barcelona, Spain.

OBJECTIVES: The study aimed to evaluate the impact of a telestroke network on

acute stroke care in Catalonia, by measuring thrombolysis rates, access to
endovascular treatment, and clinical outcome of telestroke patients in a
population-based study.
METHODS: Telestroke network was implemented on March 2013 and consists of 12
community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a
population of 1.3 million inhabitants. Rest of the population (6.2 million) of
Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke
centers (CSC). After a 2-way videoconference and visualization of neuroimaging on
a web platform, the stroke neurologist decides the therapeutic approach and/or to
transfer the patient to another facility, entering these data in a mandatory
registry. Simultaneously, all patients treated with reperfusion therapies in all
centers of Catalonia are prospectively recorded in a mandatory and audited
registry.
RESULTS: From March 2013 to December 2015, 1,206 patients were assessed by
telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT;
33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic
hemorrhage, mortality, and good outcome at 3 months were similar compared to
those who received IVT in PSC or CSC (2,897 patients in the same period). The
door-to-needle time was longer in patients treated through telestroke, but was
progressively reduced from 2013 to 2015. Percentage of patients receiving
thrombectomy after IVT was similar in patients treated through telestroke
circuit, compared to those treated in PSC or CSC (conventional circuit).
Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to
2015, especially in areas affected by the implementation of telestroke network,
achieving rates as high as 16 per 100,000 inhabitants. Transfers to another
facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5%
of transient ischemic attacks, and 23.5% of hemorrhages.
CONCLUSIONS: Telestroke favors safe and effective thrombolysis, helps to increase
the population rate of IVT, and avoids a large number of interhospital transfers.

© 2018 S. Karger AG, Basel.

DOI: 10.1159/000492124
PMID: 30134222