Visualization of the Anterior Temporal Artery as a Predictor of Outcome in Middle Cerebral Artery Occlusion Patients Achieving Successful Recanalization After Transfer

Parish, Jonathan; Rhoten, Jeremy B; Strong, Dale; Prasad, Tanushree; Hines, A.; Bernard, J; Clemente, Jonathan D.; Karamchandani, Rahul R; Asimos, Andrew W; Stetler, William R.

doi:10.7759/cureus.25173

Cited by 1 publication

(2 citation statements)

References 19 publications

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“…Clinical and radiological outcome data from our network have been published. [11][12][13][14][15][16][17] We collected data 6 months (November 2020 to April 2021) before implementing the new workflow described hereinafter and 6 months after (May 2021 to October 2021). We included all adult patients with suspected stroke symptoms presenting to one of our stroke network's nonthrombectomy facilities within 4.5 to 24 hours of LKW.…”

Section: Methodsmentioning

confidence: 99%

“…Our system includes 2 Joint Commission–certified thrombectomy centers: one is a comprehensive stroke center, and the other is thrombectomy capable certified. Clinical and radiological outcome data from our network have been published 11–17. We collected data 6 months (November 2020 to April 2021) before implementing the new workflow described hereinafter and 6 months after (May 2021 to October 2021).…”

Section: Methodsmentioning

confidence: 99%

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A Telestroke Nurse and Neuroradiologist Model for Extended Window Code Stroke Triage

Helms

Yang

Karamchandani

et al. 2023

Journal of Neuroscience Nursing

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BACKGROUND: Distinguishing features of our stroke network include routine involvement of a telestroke nurse (TSRN) for code stroke activations at nonthrombectomy centers and immediate availability of neuroradiologists for imaging interpretation. On May 1, 2021, we implemented a new workflow for code stroke activations presenting beyond 4.5 hours from last known well that relied on a TSRN supported by a neuroradiologist for initial triage. Patients without a target large vessel occlusion (LVO) were managed without routine involvement of a teleneurologist, which represented a change from the preimplementation period. METHODS: We collected data 6 months before and after implementation of the new workflow. We compared preimplementation process metrics for patients managed with teleneurologist involvement with the postimplementation patients managed without teleneurologist involvement. RESULTS: With the new workflow, teleneurologist involvement decreased from 95% (n = 953) for patients presenting beyond 4.5 hours from last known well to 37% (n = 373; P < .001). Compared with patients in the preimplementation period, postimplementation patients without teleneurologist involvement experienced less inpatient hospital admission and observation (87% vs 90%; unadjusted P = .038, adjusted P = .06). Among the preimplementation and postimplementation admitted patients, there was no statistically significant difference in follow-up neurology consultation or nonstroke diagnoses. A similar percentage of LVO patients were transferred to the thrombectomy center (54% pre vs 49% post, P = .612), whereas more LVO transfers in the postimplementation cohort received thrombectomy therapy (75% post vs 39% pre, P = .014). Among LVO patients (48 pre and 41 post), no statistical significance was observed in imaging and management times. CONCLUSION: Our work shows the successful teaming of a TSRN and a neuroradiologist to triage acute stroke patients who present beyond an eligibility window for systemic thrombolysis, without negatively impacting care and process metrics. This innovative partnering may help to preserve the availability of teleneurologists by limiting their involvement when diagnostic imaging drives decision making.

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