Decentralized Imaging by REmote Computer Tomography for Cerebral Infarct Thrombolysis

Intravenous thrombolysis (IVT) treatment is an effective treatment of disabling acute ischemic stroke (AIS) and leads to improved functional outcomes if administered within 4.5 hours after symptom onset. Since the treatment effect is highly time dependent, it is recommended to give IVT as soon as possible after symptom onset to patients with AIS without contraindications. A CT examination of the head must be performed prior to IVT to exclude intracranial hemorrhage. If an intracerebral hemorrhage (ICH) is detected rapid blood pressure lowering medication should be initiated. As of today, timely delivery of acute stroke treatment is challenging in several parts of Norway due to sparsely populated areas with long geographical distances between hospitals. Patients living in rural areas are at risk of not receiving timely acute stroke treatment. Due to the time sensitive nature of IVT, a decentralized approach to diagnostics and treatment is compelling. However, a CT scanner and medical expertise on acute stroke diagnostics and treatment is not readily available in pre-hospital settings in Norway. Investigators therefore plan to 1) assess the feasibility of widespread implementation of a model with decentralized stroke diagnostics and treatment in rural areas with a stationary CT combined with audio-and video guided support from an experienced stroke team at the local hospital 2) compare treatment access, time metrics and outcomes for stroke patients in the DMC catchment area to patients from similar rural areas without access to decentralized diagnostics and treatment. The risk for patients is minimized through remote controlled CT scanning administered from the local hospital combined with tele-stroke guided assessment by an experienced stroke team and regular simulation trainings. All treatment, including thrombolytic therapy, and monitoring routines are performed according to the hospitals' standard operating procedures (SOP). The primary objective is to compare time from Emergency Medical Communication (EMC) notification to IVT treatment between AIS patients in the intervention group comprising patients from geographical areas with an established service of prehospital stroke diagnostics and treatment at the DMC to the control group comprising patients from similar geographical areas undergoing diagnostics and treatment at their local hospital as per standard pathway.

• Time from admittance to initiation of IVT treatment (door-to-needle time) [Срок оценки: Day 0]
• Time from admittance to start of blood pressure lowering medication in ICH patients [Срок оценки: Day 0]
• Proportion of AIS patients receiving IVT treatment (y/n) [Срок оценки: Day 0]
• Proportion of AIS patients receiving EVT treatment (y/n) [Срок оценки: Day 0]
• Proportion of patients achieving early neurological improvement [Срок оценки: Day 1]
• mRS score at 90 days [Срок оценки: Month 3]
• Proportion of patients with symptomatic intracranial hemorrhage (sICH) [Срок оценки: Day 1]
• Time from symptom onset to groin puncture time [Срок оценки: Day 0]
• Transportation mode (ground or air ambulance) [Срок оценки: Day 0]
• Mortality [Срок оценки: Year 1]
• Final diagnosis [Срок оценки: Week 2]