Effects of Telestroke on Thrombolysis Times and Outcomes: A Meta-analysis

Objective: Telestroke systems are tools, used to provide an advanced stroke care in regions without sufficient neurologic services. We performed this meta-analysis to assess the effects of telemedicine on treatment times and clinical outcomes of acute stroke care. Methods: A literature search of PubMed, SCOPUS, and Cochrane CENTRAL was conducted for original studies investigating telemedicine applications in acute stroke care. Dichotomous data on treatment outcomes were pooled as odds ratios (ORs), while continuous data on thrombolysis times were pooled as mean differences (MDs) with 95% confidence interval (CI), using RevMan software (version 5.3). Results: Pooling data from 26 studies (6605 thrombolysed patients) showed no significant differences between the telestroke and control groups in terms of in-hospital mortality (OR = 1.21, 95% CI [0.98, 1.49]), 90-day mortality (OR = 1.08, 95% CI [0.85, 1.37]), symptomatic intracranial hemorrhage (sICH) (OR = 1.10, 95% CI [0.79, 1.53]), and favorable clinical outcome at discharge (OR = 1.03, 95% CI [0.69, 1.53]) and 90 days later (OR = 0.99, 95% CI [0.82, 1.18]). The onset-to-door (OTD) duration (MD = ?10.4 minutes, 95% CI [?14.79, ?.01]) and length of hospital stay (MD = ?0.55 days, 95% CI [?1.02, ?0.07]) were significantly shorter in the telestroke group, compared to the control group. Although the overall effect estimate (under the fixed-effect model) showed a significant decrease in the onset-to-treatment (OTT) duration in the telestroke group (MD = ?5.83 minutes, 95% CI [?8.57, ?3.09]), employing the random-effects model for between-study heterogeneity abolished this significance (MD = ?5.90 minutes, 95% CI [?13.23, 1.42]). Conclusion: Telestroke significantly reduced OTD and hospital stay durations in stroke patients without increasing the risk of mortality or sICH. Therefore, telemedicine can improve stroke care in regional areas with minor experience in thrombolysis. Further randomized controlled trials are needed to assess the benefits of telestroke systems, especially in terms of cost-effectiveness and quality of life outcomes.     

急性心肌梗死给予脑钠肽前体检测对溶栓治疗预后的评价

目的：本研究旨在观察成功溶栓患者中是否发生早期心血管事件,比较其血浆N氨基酸末端脑钠肽前体（NT-pro BNP）的差异,并研究其与血清肌钙蛋白T、肌酸激酶、肌酸激酶同工酶、左室射血分数、左室舒张末期容积之间的相关性,探讨测定血浆NT-pro BNP水平在评价急性心肌梗死（AMI）成功溶栓治疗的患者病情严重程度和预后的意义。方法：采用酶联免疫吸附法对61例ST段抬高型AMI患者应用瑞替普酶静脉溶栓治疗前测定NT-pro BNP。随访30 d,观察30 d内是否发生心血管死亡、心力衰竭、再发心肌梗死、梗死后心绞痛等情况。结果：两组的年龄、性别、身高、体重、吸烟与否、高血压、糖尿病以及心肌梗死的发生部位等指标比较差异无统计学意义（P〉0.05）,log NT-pro BNP水平与c Tn T、CK、CK-MB、LVEDV存在正相关（P〈0.05）,与LVEF存在负相关（P〈0.05）。结论：测定入院时血浆NT-pro BNP水平对评估AMI经过成功溶栓治疗的患者30 d内发生心血管事件有重要的临床价值。     

Treatment of acute ischemic stroke: intravenous and endovascular therapies

Stroke is the third most common cause of death in the USA, following heart disease and cancer. Intravenous recombinant tissue plasminogen activator is the only US FDA-approved pharmacological treatment available today for acute ischemic stroke. Despite the approval of this drug, it has been underutilized in the community. The limited time window of 3 h disqualifies many patients from receiving the drug. In addition, fears of intracranial hemorrhage have resulted in underutilization of the drug in the community setting. Efforts to increase the time window of treatment include utilization of the intra-arterial route for delivery of a thrombolytic drug and interventional mechanical strategies. In this article, we review the major intravenous and intra-arterial thrombolysis trials and review the mechanical strategies being developed to treat patients with acute ischemic stroke.     

Near‐normal coronary angiography in a patient,who is entirely asymptomatic 24 years after successful intracoronary thrombolysis for ST elevation myocardial infarction. Follow‐up of the historically first Czech intracoronary thrombolysis patient

Extremely long‐term follow‐up (24 years) of the historically first Czech myocardial infarction patient, treated by intracoronary thrombolysis, is presented. His current coronary angiography confirmed the finding 24 years ago, that this was a case of smoking‐induced thrombosis in otherwise healthy coronary arteries. Experience with 76 similar cases among 4093 consecutive coronary angiograms (including 778 done acutely for STEMI) is briefly described.