OBJECTIVE:

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.

METHODS:

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.

RESULTS:

•  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.

CONCLUSIONS:

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.