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The chain of care enabling tPA treatment in acute ischemic stroke: a comprehensive review of organisational models

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Abstract

Protracted and partial implementation of treatment with intravenous tissue plasminogen activator (tPA) within 4.5 h after acute stroke onset results in potentially eligible patients not receiving optimal treatment. The goal of this study was to review the performance of various organisational models of acute stroke care delivery, and subsequent attempts to improve implementation of tPA treatment. Publications comprehensively reporting on organisational models to improve implementation of i.v. tPA treatment of acute ischemic stroke patients were selected. The efficacy of organisational models was assessed using process outcome measures: thrombolysis rates, time-dependent operational endpoints (time delays), functional outcomes: safety (rate of symptomatic intracranial hemorrhage, mortality rates) and clinical outcome at 90 days (modified Rankin Scale). Fifty-eight published studies assessing organisational models were identified. Four dominant models of acute stroke care delivery were discerned, i.e., primary and comprehensive stroke centres, telemedicine, and the mobile stroke unit. Performance reported for these models suggest a large variation in administration of thrombolytic therapy (0.7–30 %). Time delays and functional outcomes found varied considerably, just like safety and mortality (0.0–11.5 %, and 3.4–31.9 %, respectively). These findings suggest that improving organisational models for tPA treatment may improve acute stroke care. However, implementation may be hampered by regional variation in acute stroke care capacity, expertise, and a fragmented approach towards organising stroke care.

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References

  1. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group(1995) N Engl J Med 333:1581–1587

  2. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, ECASS Investigators (2008) Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 359:1317–1329

    Article  PubMed  CAS  Google Scholar 

  3. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, Cohen G (2012) Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 379:2364–2372

    Article  PubMed  CAS  Google Scholar 

  4. Adeoye O, Hornung R, Khatri P, Kleindorfer D (2011) Recombinant tissue-type plasminogen activator use for ischemic stroke in the United States: a doubling of treatment rates over the course of 5 years. Stroke 42:1952–1955

    Article  PubMed  CAS  Google Scholar 

  5. Wardlaw JM, Sandercock PA, Murray V (2009) Should more patients with acute ischaemic stroke receive thrombolytic treatment? BMJ 339:b4584

    Article  PubMed  Google Scholar 

  6. Boode B, Welzen V, Franke C, van Oostenbrugge R (2007) Estimating the number of stroke patients eligible for thrombolytic treatment if delay could be avoided. Cerebrovasc Dis 23:294–298

    Article  PubMed  Google Scholar 

  7. Teuschl Y, Brainin M (2010) Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. Int J Stroke 5:187–208

    Article  PubMed  Google Scholar 

  8. Mikulik R, Bunt L, Hrdlicka D, Dusek L, Vaclavik D, Kryza J (2008) Calling 911 in response to stroke: a nationwide study assessing definitive individual behavior. Stroke 39:1844–1849

    Article  PubMed  Google Scholar 

  9. Kwan J, Hand P, Sandercock P (2004) A systematic review of barriers to delivery of thrombolysis for acute stroke. Age Ageing 33:116–121

    Article  PubMed  Google Scholar 

  10. CAEP Committee on Thrombolytic Therapy for Acute Ischemic Stroke (2001) Thrombolytic therapy for acute ischemic stroke [position statement] CEJM 3:8–12

    Google Scholar 

  11. Schwamm LH, Pancioli A, Acker JE III, Goldstein LB, Zorowitz RD, Shephard TJ, Moyer P, Gorman M, Johnston SC, Duncan PW, Gorelick P, Frank J, Stranne SK, Smith R, Federspiel W, Horton KB, Magnis E, Adams RJ, American Stroke Association’s Task Force on the Development of Stroke Systems (2005) Recommendations for the establishment of stroke systems of care: recommendations from the American Stroke Association’s Task Force on the Development of Stroke Systems. Circulation 111:1078–1091

    Google Scholar 

  12. Evenson KR, Foraker RE, Morris DL, Rosamond WD (2009) A comprehensive review of prehospital and in-hospital delay times in acute stroke care. Int J Stroke 4:187–199

    Article  PubMed  CAS  Google Scholar 

  13. Alberts MJ, Latchaw RE, Jagoda A, Wechsler LR, Crocco T, George MG, Connolly ES, Mancini B, Prudhomme S, Gress D, Jensen ME, Bass R, Ruff R, Foell K, Armonda RA, Emr M, Warren M, Baranski J, Walker MD, Brain Attack Coalition (2011) Revised and updated recommendations for the establishment of primary stroke centers: a summary statement from the brain attack coalition. Stroke 42:2651–2665

    Article  PubMed  Google Scholar 

  14. Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, Koroshetz W, Marler JR, Booss J, Zorowitz RD, Croft JB, Magnis E, Mulligan D, Jagoda A, O’Connor R, Cawley CM, Connors JJ, Rose-DeRenzy JA, Emr M, Warren M, Walker MD, Brain Attack Coalition (2005) Recommendations for comprehensive stroke centers: a consensus statement from the brain attack coalition. Stroke 36:1597–1616

    Article  PubMed  Google Scholar 

  15. Walter S, Kostopoulos P, Haass A, Keller I, Lesmeister M, Schlechtriemen T, Roth C, Papanagiotou P, Grunwald I, Schumacher H, Helwig S, Viera J, Korner H, Alexandrou M, Yilmaz U, Ziegler K, Schmidt K, Dabew R, Kubulus D, Liu Y, Volk T, Kronfeld K, Ruckes C, Bertsch T, Reith W, Fassbender K (2012) Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol 11:397–404

    Article  PubMed  Google Scholar 

  16. Wahlgren N, Ahmed N, Davalos A, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Kuelkens S, Larrue V, Lees KR, Roine RO, Soinne L, Toni D, Vanhooren G, ITS-MOST investigators (2007) Thrombolysis with alteplase for acute ischaemic stroke in the safe implementation of thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 369:275–282

    Article  PubMed  CAS  Google Scholar 

  17. Demaerschalk BM, Hwang HM, Leung G (2010) Cost analysis review of stroke centers, telestroke, and rt-PA. Am J Manag Care 16:537–544

    PubMed  Google Scholar 

  18. Stroke Unit Trialists’ Collaboration (2007) Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev (4):CD000197

  19. Demaerschalk BM, Miley ML, Kiernan TE, Bobrow BJ, Corday DA, Wellik KE, Aguilar MI, Ingall TJ, Dodick DW, Brazdys K, Koch TC, Ward MP, Richemont PC, STARR Coinvestigators (2009) Stroke telemedicine. Mayo Clin Proc 84:53–64

    Article  PubMed  Google Scholar 

  20. Fisher M (2005) Developing and implementing future stroke therapies: the potential of telemedicine. Ann Neurol 58:666–671

    Article  PubMed  Google Scholar 

  21. Meretoja A, Strbian D, Mustanoja S, Tatlisumak T, Lindsberg PJ, Kaste M (2012) Reducing in-hospital delay to 20 minutes in stroke thrombolysis. Neurology 79:306–313

    Google Scholar 

  22. Xian Y, Holloway RG, Chan PS, Noyes K, Shah MN, Ting HH, Chappel AR, Peterson ED, Friedman B (2011) Association between stroke center hospitalization for acute ischemic stroke and mortality. JAMA 305:373–380

    Article  PubMed  CAS  Google Scholar 

  23. Papapanagiotou P, Iacovidou N, Spengos K, Xanthos T, Zaganas I, Aggelina A, Alegakis A, Vemmos K (2011) Temporal trends and associated factors for pre-hospital and in-hospital delays of stroke patients over a 16-year period: the Athens study. Cerebrovasc Dis 31:199–206

    Article  PubMed  Google Scholar 

  24. Michel P, Odier C, Rutgers M, Reichhart M, Maeder P, Meuli R, Wintermark M, Maghraoui A, Faouzi M, Croquelois A, Ntaios G (2010) The Acute STroke Registry and Analysis of Lausanne (ASTRAL): design and baseline analysis of an ischemic stroke registry including acute multimodal imaging. Stroke 41:2491–2498

    Article  PubMed  Google Scholar 

  25. Meretoja A, Roine RO, Kaste M, Linna M, Roine S, Juntunen M, Erila T, Hillbom M, Marttila R, Rissanen A, Sivenius J, Hakkinen U (2010) Effectiveness of primary and comprehensive stroke centers: PERFECT stroke: a nationwide observational study from Finland. Stroke 41:1102–1107

    Article  PubMed  Google Scholar 

  26. Grotta JC, Burgin WS, El-Mitwalli A, Long M, Campbell M, Morgenstern LB, Malkoff M, Alexandrov AV (2001) Intravenous tissue-type plasminogen activator therapy for ischemic stroke: Houston experience 1996 to 2000. Arch Neurol 58:2009–2013

    Article  PubMed  CAS  Google Scholar 

  27. Koennecke HC, Nohr R, Leistner S, Marx P (2001) Intravenous tPA for ischemic stroke team performance over time, safety, and efficacy in a single-center, 2-year experience. Stroke 32:1074–1078

    Article  PubMed  CAS  Google Scholar 

  28. Prabhakaran S, McNulty M, O’Neill K, Ouyang B (2012) Intravenous thrombolysis for stroke increases over time at primary stroke centers. Stroke 43:875–877

    Article  PubMed  Google Scholar 

  29. Rajamani K, Millis S, Watson S, Mada F, Salowich-Palm L, Hinton S, Chaturvedi S (2011) Thrombolysis for acute ischemic stroke in joint commission-certified and -noncertified Hospitals in Michigan. J Stroke Cerebrovasc Dis [Epub ahead of print]

  30. Wasay M, Barohi H, Malik A, Yousuf A, Awan S, Kamal AK (2010) Utilization and outcome of thrombolytic therapy for acute stroke in Pakistan. Neurol Sci 31:223–225

    Article  PubMed  Google Scholar 

  31. Jeng JS, Tang SC, Deng IC, Tsai LK, Yeh SJ, Yip PK (2009) Stroke center characteristics which influence the administration of thrombolytic therapy for acute ischemic stroke: a national survey of stroke centers in Taiwan. J Neurol Sci 281:24–27

    Article  PubMed  Google Scholar 

  32. Demaerschalk BM, Bobrow BJ, Paulsen M, Phoenix Operation Stroke Executive Committee (2008) Development of a metropolitan matrix of primary stroke centers: the Phoenix experience. Stroke 39:1246–1253

    Article  PubMed  Google Scholar 

  33. Gropen TI, Gagliano PJ, Blake CA, Sacco RL, Kwiatkowski T, Richmond NJ, Leifer D, Libman R, Azhar S, Daley MB, NYSDOH Stroke Center Designation Project Workgroup (2006) Quality improvement in acute stroke: the New York State Stroke Center Designation Project. Neurology 67:88–93

  34. Lattimore SU, Chalela J, Davis L, DeGraba T, Ezzeddine M, Haymore J, Nyquist P, Baird AE, Hallenbeck J, Warach S, NINDS Suburban Hospital Stroke Center (2003) Impact of establishing a primary stroke center at a community hospital on the use of thrombolytic therapy: the NINDS Suburban Hospital Stroke Center experience. Stroke 34:e55–e57

    Article  PubMed  Google Scholar 

  35. Cramer SC, Stradling D, Brown DM, Carrillo-Nunez IM, Ciabarra A, Cummings M, Dauben R, Lombardi DL, Patel N, Traynor EN, Waldman S, Miller K, Stratton SJ (2012) Organization of a United States county system for comprehensive acute stroke care. Stroke 43:1089–1093

    Google Scholar 

  36. Lahr MM, Luijckx GJ, Vroomen PC, van der Zee DJ, Buskens E (2012) Proportion of patients treated with thrombolysis in a centralized versus a decentralized acute stroke care setting. Stroke 43:1336–1340

    Article  PubMed  CAS  Google Scholar 

  37. Nguyen TH, Truong AL, Ngo MB, Bui CT, Dinh QV, Doan TC, Nguyen LT, Phan TC, Phan MV, Nguyen TV, Le TV (2010) Patients with thrombolysed stroke in Vietnam have an excellent outcome: results from the Vietnam Thrombolysis Registry. Eur J Neurol 17:1188–1192

    Article  PubMed  CAS  Google Scholar 

  38. Gur AY, Shopin L, Bornstein NM (2009) Lessons learned from 2 years experience in intravenous thrombolysis for acute ischemic stroke in a single tertiary medical center. Isr Med Assoc J 11(714–6):718

    Google Scholar 

  39. McCormick MT, Reeves I, Baird T, Bone I, Muir KW (2008) Implementation of a stroke thrombolysis service within a tertiary neurosciences centre in the United Kingdom. QJM 101:291–298

    Article  PubMed  Google Scholar 

  40. Weir NU, Buchan AM (2005) A study of the workload and effectiveness of a comprehensive acute stroke service. J Neurol Neurosurg Psychiatry 76:863–865

    Article  PubMed  CAS  Google Scholar 

  41. Merino JG, Silver B, Wong E, Foell B, Demaerschalk B, Tamayo A, Poncha F, Hachinski V, Southwestern Ontario Stroke Program (2002) Extending tissue plasminogen activator use to community and rural stroke patients. Stroke 33:141–146

    Article  PubMed  CAS  Google Scholar 

  42. Rudolf J, Tsivgoulis G, Deretzi G, Heliopoulos I, Vadikolias K, Tsiptsios I, Piperidou C (2011) Feasibility and safety of intravenous thrombolysis for acute ischaemic stroke in northern Greece. Int J Stroke 6:91–92

    Article  PubMed  Google Scholar 

  43. Arkuszewski M, Targosz-Gajniak M, Swiat M, Patalong-Ogiewa M, Pieta M, Opala G (2011) Intravenous thrombolysis in acute ischemic stroke after POLKARD: one center analysis of program impact on clinical practice. Adv Med Sci 56:231–240

    Article  PubMed  CAS  Google Scholar 

  44. Sharma VK, Tsivgoulis G, Tan JH, Wong LY, Ong BK, Chan BP, Teoh HL (2010) Feasibility and safety of intravenous thrombolysis in multiethnic Asian stroke patients in Singapore. J Stroke Cerebrovasc Dis 19:424–430

    Article  PubMed  Google Scholar 

  45. Pervez MA, Silva G, Masrur S, Betensky RA, Furie KL, Hidalgo R, Lima F, Rosenthal ES, Rost N, Viswanathan A, Schwamm LH (2010) Remote supervision of IV-tPA for acute ischemic stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke 41:e18–e24

    Article  PubMed  Google Scholar 

  46. Rymer MM, Thurtchley D, Summers D, America Brain Stroke Institute Stroke Team (2003) Expanded modes of tissue plasminogen activator delivery in a comprehensive stroke center increases regional acute stroke interventions. Stroke 34:e58–e60

    Article  PubMed  Google Scholar 

  47. Chapman KM, Woolfenden AR, Graeb D, Johnston DC, Beckman J, Schulzer M, Teal PA (2000) Intravenous tissue plasminogen activator for acute ischemic stroke: A Canadian hospital’s experience. Stroke 31:2920–2924

    Article  PubMed  CAS  Google Scholar 

  48. Perez de la Ossa N, Millan M, Arenillas JF, Sanchez-Ojanguren J, Palomeras E, Dorado L, Guerrero C, Davalos A (2009) Influence of direct admission to Comprehensive Stroke Centers on the outcome of acute stroke patients treated with intravenous thrombolysis. J Neurol 256:1270–1276

    Article  PubMed  Google Scholar 

  49. Demaerschalk BM, Raman R, Ernstrom K, Meyer BC (2012) Efficacy of telemedicine for stroke: pooled analysis of the stroke team remote evaluation using a digital observation camera (STRokE DOC) and STRokE DOC Arizona telestroke trials. Telemed J E Health 18:230–237

    Article  PubMed  Google Scholar 

  50. Lazaridis C, Desantis SM, Jauch EC, Adams RJ (2011) Telestroke in South Carolina. J Stroke Cerebrovasc Dis [Epub ahead of print]

  51. Sairanen T, Soinila S, Nikkanen M, Rantanen K, Mustanoja S, Farkkila M, Pieninkeroinen I, Numminen H, Baumann P, Valpas J, Kuha T, Kaste M, Tatlisumak T, Finnish Telestroke Task Force (2011) Two years of Finnish Telestroke: thrombolysis at spokes equal to that at the hub. Neurology 76:1145–1152

    Article  PubMed  CAS  Google Scholar 

  52. Zaidi SF, Jumma MA, Urra XN, Hammer M, Massaro L, Reddy V, Jovin T, Lin R, Wechsler LR (2011) Telestroke-guided intravenous tissue-type plasminogen activator treatment achieves a similar clinical outcome as thrombolysis at a comprehensive stroke center. Stroke 42:3291–3293

    Article  PubMed  CAS  Google Scholar 

  53. Demaerschalk BM, Bobrow BJ, Raman R, Kiernan TE, Aguilar MI, Ingall TJ, Dodick DW, Ward MP, Richemont PC, Brazdys K, Koch TC, Miley ML, Hoffman Snyder CR, Corday DA, Meyer BC, STRokE DOC AZ TIME Investigators (2010) Stroke team remote evaluation using a digital observation camera in Arizona: the initial mayo clinic experience trial. Stroke 41:1251–1258

    Article  PubMed  Google Scholar 

  54. Moynihan B, Davis D, Pereira A, Cloud G, Markus HS (2010) Delivering regional thrombolysis via a hub-and-spoke model. J R Soc Med 103:363–369

    Article  PubMed  Google Scholar 

  55. Switzer JA, Hall C, Gross H, Waller J, Nichols FT, Wang S, Adams RJ, Hess DC (2009) A web-based telestroke system facilitates rapid treatment of acute ischemic stroke patients in rural emergency departments. J Emerg Med 36:12–18

    Article  PubMed  Google Scholar 

  56. Meyer BC, Raman R, Hemmen T, Obler R, Zivin JA, Rao R, Thomas RG, Lyden PD (2008) Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol 7:787–795

    Article  PubMed  CAS  Google Scholar 

  57. Schwab S, Vatankhah B, Kukla C, Hauchwitz M, Bogdahn U, Furst A, Audebert HJ, Horn M, TEMPiS Group (2007) Long-term outcome after thrombolysis in telemedical stroke care. Neurology 69:898–903

    Google Scholar 

  58. Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL, Telemedic Pilot Project for Integrative Stroke Care Group (2006) Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Lancet Neurol 5:742–748

    Google Scholar 

  59. Audebert HJ, Kukla C, Vatankhah B, Gotzler B, Schenkel J, Hofer S, Furst A, Haberl RL (2006) Comparison of tissue plasminogen activator administration management between Telestroke Network hospitals and academic stroke centers: the Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany. Stroke 37:1822–1827

    Article  PubMed  CAS  Google Scholar 

  60. Audebert HJ, Kukla C, Clarmann von Claranau S, Kuhn J, Vatankhah B, Schenkel J, Ickenstein GW, Haberl RL, Horn M, TEMPiS Group (2005) Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria. Stroke 36:287–291

  61. Hess DC, Wang S, Hamilton W, Lee S, Pardue C, Waller JL, Gross H, Nichols F, Hall C, Adams RJ (2005) REACH: clinical feasibility of a rural telestroke network. Stroke 36:2018–2020

    Article  PubMed  Google Scholar 

  62. Wang S, Gross H, Lee SB, Pardue C, Waller J, Nichols FT III, Adams RJ, Hess DC (2004) Remote evaluation of acute ischemic stroke in rural community hospitals in Georgia. Stroke 35:1763–1768

    Article  PubMed  Google Scholar 

  63. Frey JL, Jahnke HK, Goslar PW, Partovi S, Flaster MS (2005) tPA by telephone: extending the benefits of a comprehensive stroke center. Neurology 64:154–156

    Article  PubMed  CAS  Google Scholar 

  64. Mansoor S, Zand R, Al-Wafai A, Wahba MN, Giraldo EA (2012) Safety of a “Drip and Ship” intravenous thrombolysis protocol for patients with acute ischemic stroke. J Stroke Cerebrovasc Dis [Epub ahead of print]

  65. Chowdhury M, Birns J, Rudd A, Bhalla A (2012) Telemedicine versus face-to-face evaluation in the delivery of thrombolysis for acute ischaemic stroke: a single centre experience. Postgrad Med J 88:134–137

    Article  PubMed  Google Scholar 

  66. Qureshi AI, Chaudhry SA, Rodriguez GJ, Suri MF, Lakshminarayan K, Ezzeddine MA (2012) Outcome of the ‘Drip-and-Ship’ paradigm among patients with acute ischemic stroke: results of a statewide study. Cerebrovasc Dis Extra 2:1–8

    Article  PubMed  Google Scholar 

  67. Rudd M, Rodgers H, Curless R, Sudlow M, Huntley S, Madhava B, Garside M, Price CI (2012) Remote specialist assessment for intravenous thrombolysis of acute ischaemic stroke by telephone. Emerg Med J 29:704–708

    Google Scholar 

  68. Johansson T, Mutzenbach SJ, Ladurner G (2011) Telemedicine in acute stroke care: the TESSA model. J Telemed Telecare 17:268–272

    Article  PubMed  Google Scholar 

  69. Martin-Schild S, Morales MM, Khaja AM, Barreto AD, Hallevi H, Abraham A, Sline MR, Jones E, Grotta JC, Savitz SI (2011) Is the drip-and-ship approach to delivering thrombolysis for acute ischemic stroke safe? J Emerg Med 41:135–141

    Article  PubMed  Google Scholar 

  70. Waite K, Silver F, Jaigobin C, Black S, Lee L, Murray B, Danyliuk P, Brown EM (2006) Telestroke: a multi-site, emergency-based telemedicine service in Ontario. J Telemed Telecare 12:141–145

    Article  PubMed  Google Scholar 

  71. Vaishnav AG, Pettigrew LC, Ryan S (2008) Telephonic guidance of systemic thrombolysis in acute ischemic stroke: safety outcome in rural hospitals. Clin Neurol Neurosurg 110:451–454

    Article  PubMed  Google Scholar 

  72. Wiborg A, Widder B, Telemedicine in Stroke in Swabia Project (2003) Teleneurology to improve stroke care in rural areas: The Telemedicine in Stroke in Swabia (TESS) Project. Stroke 34:2951–2956

    Google Scholar 

  73. LaMonte MP, Bahouth MN, Hu P, Pathan MY, Yarbrough KL, Gunawardane R, Crarey P, Page W (2003) Telemedicine for acute stroke: triumphs and pitfalls. Stroke 34:725–728

    Article  PubMed  CAS  Google Scholar 

  74. Dharmasaroja PA, Muengtaweepongsa S, Kommarkg U (2010) Implementation of telemedicine and stroke network in thrombolytic administration: comparison between walk-in and referred patients. Neurocrit Care 13:62–66

    Article  PubMed  Google Scholar 

  75. Ickenstein GW, Horn M, Schenkel J, Vatankhah B, Bogdahn U, Haberl R, Audebert HJ (2005) The use of telemedicine in combination with a new stroke-code-box significantly increases t-PA use in rural communities. Neurocrit Care 3:27–32

    Article  PubMed  Google Scholar 

  76. Schwamm LH, Rosenthal ES, Hirshberg A, Schaefer PW, Little EA, Kvedar JC, Petkovska I, Koroshetz WJ, Levine SR (2004) Virtual telestroke support for the emergency department evaluation of acute stroke. Acad Emerg Med 11:1193–1197

    Article  PubMed  Google Scholar 

  77. Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks EF, American Heart Association/American Stroke Association Stroke Council, American Heart Association/American Stroke Association Clinical Cardiology Council, American Heart Association/American Stroke Association Cardiovascular Radiology and Intervention Council, Atherosclerotic Peripheral Vascular Disease Working Group, Quality of Care Outcomes in Research Interdisciplinary Working Group (2007) Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation 115:e478–534

    Google Scholar 

  78. European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 25:457–507

    Google Scholar 

  79. Acker JE 3rd, Pancioli AM, Crocco TJ, Eckstein MK, Jauch EC, Larrabee H, Meltzer NM, Mergendahl WC, Munn JW, Prentiss SM, Sand C, Saver JL, Eigel B, Gilpin BR, Schoeberl M, Solis P, Bailey JR, Horton KB, Stranne SK, American Heart Association, American Stroke Association Expert Panel on Emergency Medical Services Systems, Stroke Council (2007) Implementation strategies for emergency medical services within stroke systems of care: a policy statement from the American Heart Association/American Stroke Association Expert Panel on Emergency Medical Services Systems and the Stroke Council. Stroke 38:3097–3115

    Google Scholar 

  80. Leifer D, Bravata DM, Connors JJ 3rd, Hinchey JA, Jauch EC, Johnston SC, Latchaw R, Likosky W, Ogilvy C, Qureshi AI, Summers D, Sung GY, Williams LS, Zorowitz R, American Heart Association Special Writing Group of the Stroke Council, Atherosclerotic Peripheral Vascular Disease Working Group, Council on Cardiovascular Surgery and Anesthesia, Council on Cardiovascular Nursing (2011) Metrics for measuring quality of care in comprehensive stroke centers: detailed follow-up to brain attack coalition comprehensive stroke center recommendations: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 42:849–877

    Google Scholar 

  81. Gropen T, Magdon-Ismail Z, Day D, Melluzzo S, Schwamm LH, NECC Advisory Group (2009) Regional implementation of the stroke systems of care model: recommendations of the northeast cerebrovascular consortium. Stroke 40:1793–1802

    Google Scholar 

  82. Stahl JE, Furie KL, Gleason S, Gazelle GS (2003) Stroke: Effect of implementing an evaluation and treatment protocol compliant with NINDS recommendations. Radiology 228:659–668

    Article  PubMed  Google Scholar 

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Acknowledgments

Netherlands Organisation for Health Research and Development (ZonMw). Ref: 80-82800-98-104.

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  1. Department of Neurology, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands

    Maarten M. H. Lahr, Gert-Jan Luijckx & Patrick C. A. J. Vroomen

  2. Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands

    Durk-Jouke van der Zee

  3. Medical Technology Assessment, Department of Epidemiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands

    Erik Buskens

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  1. Maarten M. H. Lahr
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Lahr, M.M.H., Luijckx, GJ., Vroomen, P.C.A.J. et al. The chain of care enabling tPA treatment in acute ischemic stroke: a comprehensive review of organisational models. J Neurol 260, 960–968 (2013). https://doi.org/10.1007/s00415-012-6647-7

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