Abstract:Introduction:The establishment of stroke networks is an approach to forward guideline-driven stroke care to hospitals without full-time neurological service.Telestroke networks are evidence based for ...Introduction:The establishment of stroke networks is an approach to forward guideline-driven stroke care to hospitals without full-time neurological service.Telestroke networks are evidence based for remote neurological support of acute stroke patients, administration of thrombolysis safely as well as increasing thrombolysis rates.Thus, aim of our efforts is the dissemination of high-quality stroke care to rural areas.Methods: In a pilot project we linked the district hospital in Grabs to the stroke center at the cantonal hospital St. Gallen and provided teleconsultations with full-scale audiovisual communication and access to brain images 24 hours per day 7 days per week.This telestroke concept was embedded in an acute stroke care concept and included mobile as well as hospital-based teleconsulting.We prospectively recorded parameters for quality control before and after implementation of the telestroke project in February 2011.Results: In a cohort of 57 acute stroke patients, 49 teleconsultations were conducted between end of February and July 2011, 10 patients received systemic thrombolysis, one patient was selected for bridging-therapy, initiated by the systemic application of rt-PA in the district hospital and accomplishment of treatment at the stroke center.Compared to 33 patients treated with systemic thrombolysis before implementation of telestroke, symptom-onset-to-door times (84 ± 47 vs. 97 ± 68 minutes) and door-to-CT times (23 ± 6 vs. 22 ± 9 minutes) were similar whereas door-to-needle times dropped markedly (45 ± 12 vs.71 ± 29 minutes).Regarding safety issues using the telestroke network no intracerebral hemorrhage or in-hospital mortality occurred in the 11 patients mentioned above.The patients were older and had more severe deficits than patients treated before (mean age 78.9 vs. 69.9years and median NIHSS 9 vs. 7). Conclusion:The preliminary data of our telestroke network are promising regarding quality and safety issues.This includes the selection of patients for appropriate treatment with allocation to systemic thrombolysis or bridging-therapy.As perspective it may definitely contribute to better supply of rural areas with acute stroke therapy.Read More