Imaging of prehospital stroke therapeutics

Abstract

Despite significant quality improvement efforts to streamline in-hospital acute stroke care in the conventional model, there remain inherent layers of treatment delays, which could be eliminated with prehospital diagnostics and therapeutics administered in a mobile stroke unit. Early diagnosis using telestroke and neuroimaging while in the ambulance may enable targeted routing to hospitals with specialized care, which will likely improve patient outcomes. Key clinical trials in telestroke, mobile stroke units with prehospital neuroimaging capability, prehospital ultrasound and co-administration of various classes of neuroprotectives, antiplatelets and antithrombin agents with intravenous thrombolysis are discussed in this article.

Keywords:

• mobile stroke unit
• prehospital therapeutics
• stroke
• telemedicine
• thrombolysis

Financial & competing interests disclosure

DS Liebeskind is supported by funding from the NIH-National Institute of Neurological Disorders and Stroke (grant number: K24NS072272). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key issues

• Rapid intravenous thrombolysis treatment and patient selection are keys to optimal stroke outcomes.

• Telestroke is a feasible (and reliable) mean to improve remote access to stroke experts, and thereby increases tPA administration rate, and shortens time to tPA treatment.

• There is acceptable inter-rater agreement between telestroke neurologist and neuroradiology on neuroimaging interpretations to validate rapid transmissions of neuroimaging in telestroke.

• Mobile stroke unit (MSU) equipped with CT scanner, point-of-care laboratory, telestroke enables early stroke diagnosis, rapid tPA treatment and early triage with targeted ambulance routing to hospitals with specialized care.

• Studies to evaluate the impact of MSU on long-term clinical outcome are needed.

• Centers around the world will need to customize their prehospital treatment via MSU to fit the characteristics and limitations of their communities.

• Prehospital stroke management enables treatment trials in the ‘golden hour’ when neuroprotective and neurotherapeutic agents may be most effective.

• Thrombolysis enhancers like transcranial ultrasonography or combined thrombolysis with antiplatelets or antithrombin may prevent re-occlusion after reperfusion therapy.

Notes