Abstract Body: Background: Efficient management of acute ischemic stroke is critical to reducing disability and mortality. The hub-and-spoke telestroke model has been developed to extend specialized stroke care to regions with limited resources, ensuring timely diagnosis and treatment.
Objective: To evaluate the effectiveness of a large-scale hub-and-spoke telestroke network in delivering acute stroke care, focusing on the rates of thrombolysis and mechanical thrombectomy, treatment timelines, and patient outcomes.
Methods: We conducted a retrospective analysis of 9,702 patients treated within a 38-hospital telestroke network from December 2014 to January 2018. Data collected included patient demographics, stroke characteristics, treatment interventions, and outcomes. Key measures included the proportion of patients receiving intravenous tissue plasminogen activator (IV tPA), mechanical thrombectomy, time from stroke onset to treatment, and rates of complications and discharge outcomes.
Results: Of the 9,702 patients included, 83.1% were diagnosed with a true stroke, and the mean NIHSS score on admission was 6.2. IV tPA was recommended for 16.3% of patients, with 61.7% receiving the treatment. Mechanical thrombectomy was performed in 2.3% of cases, with an average procedure duration of 46.2 minutes. The median time from stroke onset to IV tPA administration was 114.2 minutes. Hemorrhagic transformation occurred in 19.4% of patients who received thrombolysis, and the overall mortality rate was 17.4%. The average NIHSS score at discharge improved to 4.4, with 54.9% of patients discharged home.
Conclusion: The hub-and-spoke telestroke network demonstrated significant efficacy in delivering timely, specialized stroke care across a large and diverse patient cohort. By reducing treatment delays and optimizing access to advanced interventions, this model has the potential to transform stroke care in underserved regions, reducing both mortality and long-term disability.