Medical University of South Carolina Telestroke: A Telemedicine Facilitated Network for Stroke Treatment in South Carolina-A Progress Report.

BACKGROUND: Patients in rural communities lack access to acute stroke therapies. Rapid administration of lytic therapy increases the likelihood of favorable functional outcome in acute ischemic stroke (AIS). At the Medical University of South Carolina (MUSC), we implemented a Web-based telestroke program that allows patients presenting with AIS at a rural hospital to receive expert stroke consultation within minutes. This increases their chances of receiving lytic therapy, and therefore increases the likelihood of good functional outcome.

OBJECTIVES: Our study aims to provide an update on how our telestroke program had developed and the rate and safety of intravenous (IV) alteplase administration through telestroke.

METHODS: Data were collected on all patients evaluated through the MUSC Telestroke program from May 2008 through April 2014. Collected data included National Institutes of Health Stroke Scale (NIHSS) on presentation, number of IV alteplase administrations, number of patients transferred to MUSC, number of mechanical thrombectomies performed on transferred patients, rate of symptomatic intracerebral hemorrhages (sICHs), and discharge location.

RESULTS: A total of 7,694 consults were performed during the study period. Of them 3,795 (49.2%) patients were diagnosed with ischemic stroke, of those 1,324 (34.8%) received IV alteplase. A total of 1,282 patients were transferred to MUSC for further care. From November 2014 to April 2016, 56 patients received mechanical thrombectomy. sICH occurred in 33 patients who received alteplase, and in 5 patients receiving a combination of IV and intraarterial thrombolysis. Over the study period, the number of participating sites increased from 6 to 19 sites. The percentage of transfers to MUSC decreased from 36% to 14%.

CONCLUSIONS: Our study shows that our telestroke program had evolved over time to involve more sites throughout the state of South Carolina. Post-IV alteplase sICH was low and within the expected range.