The aim of this systematic review and meta-analysis was to evaluate the safety and efficacy of IV thrombolysis (IVT) with tissue plasminogen activator (tPA) delivered through telestroke networks in patients with acute ischemic stroke.
We conducted a systematic review and meta-analysis according of prospective randomized controlled and nonrandomized studies comparing telemedicine-guided IVT to IVT administered at stroke centers and were published from the earliest date available until April 1, 2015.
- Outcomes of interest were symptomatic intracerebral hemorrhage,
- mortality, and functional independence (modified Rankin Scale scores 0-1) at 3 months.
- 1,863 patients fulfilled our eligibility criteria.
- Among these, thrombolysis was largely restricted to the 3-hour time window.
- Symptomatic intracerebral hemorrhage rates were similar between patients subjected to telemedicine-guided IVT and those receiving tPA at stroke centers
- There was no difference in mortality or in functional independence at 3 months between telemedicine-guided and stroke center thrombolysis.
Our findings indicate that IV tPA delivery through telestroke networks is safe and effective in the 3-hour time window. Lack of prospective trials, however, emphasizes the need to further substantiate these findings in the 3- to 4.5-hour time window.
© 2016 American Academy of Neurology.