Background and Purpose:Systemic thrombolysis represents the only proven thera py for acute ischemic stroke, but safe treatment is reported only in established stroke units. One major goal of the ongoing Telemedic Pilot Project for Integra tive Stroke Care (TEMPiS) in Bavaria is to extend the use of tissue plasminogen activator (tPA) treatment in nonurban areas through telemedic support. Methods: The stroke centers in Munich-Harlaching and in Regensburg established a telestr oke network to provide consultations for 12 local hospitals in eastern Bavaria. The telemedic system consists of a digital network that includes a 2-way video conference system and CT/MRI image transfer with a high-speed data transmission up to 2 Mb/s. Each network hospital established specialized stroke wards in whi ch qualified teams treat acute stroke patients. Physicians in these hospitals ar e able to contact the stroke centers 24 hours per day. Results:A total of 106 s ystemic thrombolyses were indicated via teleconsultations between February 1, 20 03, and April 7, 2004. During the first 12 months,the rate of thrombolyses was 2 .1%of all stroke patients.Mean age was 68 years, and median National Institutes of Health Stroke Scale score was 13. Mean delay between onset and hospital admi ssion was 65 minutes, and door-to-needle time was on average 76 minutes, which included 15 minutes for the teleconsultation. Symptomatic hemorrhage occurred i n 8.5%of patients, and in-hospital mortality was 10.4%. Conclusions:The pres ent data suggest that systemic thrombolysis indicated via stroke experts in the setting of teleconsultation exhibits similar complication rates to those reporte d in the National Institute of Neurological Disorders and Stroke trial. Therefor e, tPA treatment is also safe in this context and can be extended to nonurban ar eas.
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