Journal of Neural Transmission

, Volume 120, Supplement 1, pp 43–47 | Cite as

Why Telestroke networks? Rationale, implementation and results of the Stroke Eastern Saxony Network

Neurology and Preclinical Neurological Studies - Review Article


Stroke is the third leading cause of death and the leading cause of acquired long-term disability in Europe and North America. Intravenous (IV) thrombolysis with alteplase and organized inpatient (stroke unit) care have been shown to improve stroke patients’ functional outcomes. However, stroke unit care is not area-wide available and thrombolysis rates are low, partly due to limited stroke thrombolysis expertise in smaller community hospitals. Telemedical stroke networks (Telestroke network) with remote video assessment of patients and brain computed tomography (CT) scans by stroke neurologists have been shown to increase IV thrombolysis rates and functional outcomes of patients in smaller community hospitals. Our article summarizes the rationale, clinical, and currently published scientific results of Telestroke networks with special respect to the telemedical Stroke Eastern Saxony Network (SOS-NET), which has been established by the Dresden University Stroke Center (DUSC) in July 2007. From July 2007 to December 2012, 3416 teleconsultations have been performed within the SOS-NET.


Telemedicine Telestroke Thrombolysis Stroke care 


Conflict of interest

This paper was not sponsored by outside commercial interests.


  1. Audebert HJ, Kukla C, Clarmann von Claranau S, Kuhn J, Vatankhah B, Schenkel J, Ickenstein GW, Haberl RL, Horn M (2005) Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria. Stroke 36(2):287–291. doi: 10.1161/01.STR.0000153015.57892.66 PubMedCrossRefGoogle Scholar
  2. Audebert HJ, Kukla C, Vatankhah B, Gotzler B, Schenkel J, Hofer S, Furst A, Haberl RL (2006a) 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(7):1822–1827. doi: 10.1161/01.STR.0000226741.20629.b2 PubMedCrossRefGoogle Scholar
  3. Audebert HJ, Schenkel J, Heuschmann PU, Bogdahn U, Haberl RL (2006b) Effects of the implementation of a telemedical stroke network: the Telemedic Pilot Project for Integrative Stroke Care (TEMPiS) in Bavaria, Germany. Lancet Neurol 5(9):742–748. doi: 10.1016/S1474-4422(06)70527-0 PubMedCrossRefGoogle Scholar
  4. Group TNIoNDaSr-PSS (1995) Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 333(24):1581–1587CrossRefGoogle Scholar
  5. 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 (2008) Thrombolysis with alteplase 3 to 4.5 h after acute ischemic stroke. N Engl J Med 359(13):1317–1329. doi: 10.1056/NEJMoa0804656 PubMedCrossRefGoogle Scholar
  6. Handschu R, Garling A, Heuschmann PU, Kolominsky-Rabas PL, Erbguth F, Neundorfer B (2001) Acute stroke management in the local general hospital. Stroke 32(4):866–870PubMedCrossRefGoogle Scholar
  7. Heuschmann PU, Biegler MK, Busse O, Elsner S, Grau A, Hasenbein U, Hermanek P, Janzen RW, Kolominsky-Rabas PL, Kraywinkel K, Lowitzsch K, Misselwitz B, Nabavi DG, Otten K, Pientka L, von Reutern GM, Ringelstein EB, Sander D, Wagner M, Berger K (2006) Development and implementation of evidence-based indicators for measuring quality of acute stroke care: the Quality Indicator Board of the German Stroke Registers Study Group (ADSR). Stroke 37(10):2573–2578. doi: 10.1161/01.STR.0000241086.92084.c0 PubMedCrossRefGoogle Scholar
  8. Johnston KC, Worrall BB (2003) Teleradiology Assessment of Computerized Tomographs Online Reliability Study (TRACTORS) for acute stroke evaluation. Telemed J E Health 9(3):227–233. doi: 10.1089/153056203322502605 PubMedCrossRefGoogle Scholar
  9. Kepplinger J, Dzialowski I, Barlinn K, Puetz V, Wojciechowski C, Schneider H, Gahn G, Back T, Schackert G, Reichmann H, von Kummer R, Bodechtel U (2013) Emergency transfer of acute stroke patients within the East Saxony telemedicine stroke network: a descriptive analysis. Int J Stroke. doi: 10.1111/ijs.12032
  10. Leys D, Ringelstein EB, Kaste M, Hacke W (2007) Facilities available in European hospitals treating stroke patients. Stroke 38(11):2985–2991. doi: 10.1161/STROKEAHA.107.487967 PubMedCrossRefGoogle Scholar
  11. Lloyd-Jones D, Adams R, Carnethon M, De Simone G, Ferguson TB, Flegal K, Ford E, Furie K, Go A, Greenlund K, Haase N, Hailpern S, Ho M, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott M, Meigs J, Mozaffarian D, Nichol G, O’Donnell C, Roger V, Rosamond W, Sacco R, Sorlie P, Stafford R, Steinberger J, Thom T, Wasserthiel-Smoller S, Wong N, Wylie-Rosett J, Hong Y (2009) Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 119(3):e21–e181. doi: 10.1161/CIRCULATIONAHA.108.191261 PubMedCrossRefGoogle Scholar
  12. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (2006) Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367(9524):1747–1757. doi: 10.1016/S0140-6736(06)68770-9 PubMedCrossRefGoogle Scholar
  13. Muller-Barna P, Audebert HJ (2013) High-standard TeleStroke: need for experienced stroke experts trained in imaging interpretation. Neurology 80(4):326–327. doi: 10.1212/WNL.0b013e31827f0948 Google Scholar
  14. 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(1):e18–24. doi: 10.1161/STROKEAHA.109.560169 Google Scholar
  15. Puetz V, Dzialowski I, Hill MD, Demchuk AM (2009) The Alberta Stroke Program Early CT Score in clinical practice: what have we learned? Int J Stroke 4(5):354–364. doi: 10.1111/j.1747-4949.2009.00337.x PubMedCrossRefGoogle Scholar
  16. Puetz V, Bodechtel U, Gerber JC, Dzialowski I, Kunz A, Wolz M, Hentschel H, Schultheiss T, Kepplinger J, Schneider H, Wiedemann B, Wojciechowski C, Reichmann H, Gahn G, von Kummer R (2013) Reliability of brain CT evaluation by stroke neurologists in telemedicine. Neurology 80(4):332–338. doi: 10.1212/WNL.0b013e31827f07d0 Google Scholar
  17. Reeves MJ, Arora S, Broderick JP, Frankel M, Heinrich JP, Hickenbottom S, Karp H, LaBresh KA, Malarcher A, Mensah G, Moomaw CJ, Schwamm L, Weiss P (2005) Acute stroke care in the US: results from 4 pilot prototypes of the Paul Coverdell National Acute Stroke Registry. Stroke 36(6):1232–1240. doi: 10.1161/01.STR.0000165902.18021.5b PubMedCrossRefGoogle Scholar
  18. 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 (2011) Two years of Finnish Telestroke: thrombolysis at spokes equal to that at the hub. Neurology 76(13):1145–1152. doi: 10.1212/WNL.0b013e318212a8d4 Google Scholar
  19. Schwab S, Vatankhah B, Kukla C, Hauchwitz M, Bogdahn U, Furst A, Audebert HJ, Horn M (2007) Long-term outcome after thrombolysis in telemedical stroke care. Neurology 69(9):898–903. doi: 10.1212/01.wnl.0000269671.08423.14 PubMedCrossRefGoogle Scholar
  20. Schwamm LH, Audebert HJ, Amarenco P, Chumbler NR, Frankel MR, George MG, Gorelick PB, Horton KB, Kaste M, Lackland DT, Levine SR, Meyer BC, Meyers PM, Patterson V, Stranne SK, White CJ (2009) Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke 40(7):2635–2660. doi: 10.1161/STROKEAHA.109.192361 PubMedCrossRefGoogle Scholar
  21. Seenan P, Long M, Langhorne P (2007) Stroke units in their natural habitat: systematic review of observational studies. Stroke J Cerebral Circ 38(6):1886–1892. doi: 10.1161/STROKEAHA.106.480871 CrossRefGoogle Scholar
  22. The Basilar Artery International Cooperation Study (BASICS). (last assessed March 11th, 2013)
  23. Wang S, Lee SB, Pardue C, Ramsingh D, Waller J, Gross H, Nichols FT 3rd, Hess DC, Adams RJ (2003) Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health Stroke Scale via telestroke. Stroke 34(10):e188–e191. doi: 10.1161/01.STR.0000091847.82140.9 PubMedCrossRefGoogle Scholar
  24. 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(11):3291–3293. doi: 10.1161/STROKEAHA.111.625046 Google Scholar
  25. Zerna C, Puetz V, Dzialowski I, Wojciechowski C, Kepplinger J, Gahn G, Reichmann H, von Kummer R, Bodechtel U (2013) The Stroke Eastern Saxony network: an evaluation of telemedical thrombolysis in Telestroke over 5 years. Cerebrovasc Dis 35(3):654Google Scholar

Copyright information

© European Union  2013

Authors and Affiliations

  1. 1.Dresden University Stroke Center, Department of NeurologyUniversity Clinics DresdenDresdenGermany

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