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Utilization of Vascular Surgical Services in a Hub-and-Spoke Telestroke Network
Grant T. Fankhauser, MD, William M. Stone, MD, Mark E. O'Donnell, MD, Richard J. Fowl, MD, Bart M. Demaerschalk, MD, Samuel R. Money, MD.
Mayo Clinic Arizona, Phoenix, AZ, USA.
OBJECTIVES:
Telemedicine is a disruptive technological advance that may impact surgical practices. Roughly 700,000 American suffer acute strokes each year and one-half of these patients do not live in a metropolitan area with a primary stroke center (PSC). A single Hub - ten spoke hospital Telemedicine Stroke (Telestroke) network has been in operation since 2007. Our purpose was to review the spoke hospital patients for whom telestroke consultation was conducted and determine the impact on a hub vascular surgical practice.
METHODS:
A prospectively maintained database of all patients undergoing telestroke consultation from December 2007-May 2012 was reviewed. Patients referred for vascular surgical consultation at our institution, following telestroke consultation, were identified. Patient demographic information, diagnosis, imaging studies, interventions, and follow-up were recorded.
RESULTS:
953 patients underwent telestroke consultation during the study period. Seven patients (0.7%) received vascular surgical consultation after the telestroke consultation (4 men, 3 women, mean age=73). Four consultations occurred on an outpatient basis. Three consultations were conducted in the hospital after the patients were transferred for primary stroke center care. Four patients underwent 6 operations after consultation (2 carotid endarterectomies, 4 carotid angioplasties and stents). Mean follow-up was 200 days (range= 24-320). There were no periprocedural complications, strokes, or deaths. One patient developed in-stent stenosis and redo stenting was required 292 days after initial carotid stent placement. One patient underwent bilateral carotid stent placement. There have been no recurrent strokes in mid-term follow-up.
CONCLUSIONS:
Telestroke consultations offer expert stroke care to remote community hospitals. Few consultations with vascular surgeons are generated from the telestroke service but there is a high rate of intervention after consultation with vascular surgery. Patients undergoing vascular surgery after telestroke consultation would likely not have pursued surgery at our institution without the telestroke program.
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