Reliability of Prehospital Real-Time Cellular Video Phone in Assessing the Simplified National Institutes of Health Stroke Scale in Patients With Acute Stroke A Novel Telemedicine Technology

Background and Purpose-The National Institutes of Health Stroke Scale (NIHSS) is the gold standard to assess patients with acute stroke. We aimed to examine the feasibility and reliability of prehospital real-time cellular video phone (VP) in performing the NIHSS. Methods-Forty physicians prospectively performed a simplified NIHSS (sNIHSS) on a standardized patient remotely using VP with the assistance of a bedside emergency medical technician and later performed a bedside examination. We tested the hypothesis that there is high reliability between these 2 methods. Physicians were timed and sNIHSS scores were recorded. Finally, physicians were asked to rate the VP technology. Results-A total of 480 pair comparisons of the sNIHSS scores between the VP and bedside examination were generated. After adjusting for the physician's specialty, level of training, and certification status, there was a strong positive linear correlation (rϭ0.97, PϽ0.01) between the 2 methods with high average physician reliability (0.99; 95% CI, 0.992 to 0.995). The mean sNIHSS scores using VP and bedside examination were not different (6.82Ϯ1.06 versus 6.63Ϯ0.98; Pϭ0.08). The mean time to perform the sNIHSS using VP was approximately 38 seconds longer than the bedside examination (3.38Ϯ0.77 versus 2.93Ϯ0.83 minutes; Pϭ0.006). Conclusions-The VP is a feasible, reliable, and timely tool with the potential for remotely assessing the sNIHSS for patients presenting with acute stroke and may expedite the initial evaluation and treatment strategies. (Stroke. 2011; 42:00-00.

773-4 Long Term Efficacy and Safety of Endovascular Low Dose Irradiation In a Swine Model of Restenosis After Angloplasty

Restenosis after balloon angioplasty is characterized by neointima formation. We have previously shown that ionizing radiation reduce neointima formation two weeks after angioplasty in a swine model of restenosis. To determine the durability of this effect and the long term safety after endovascular irradiation twenty one miniswine coronary arteries underwent overstretch balloon injury with a 3.5mm angioplasty balloon in the LAD, LCX and RCA. High energy 1921ridium source was introduced immediately by random assignment to deliver 700 or 1400 cGy in 14 injured coronary arteries (LAD and CX). Six months later an angiogram was performed, the animals were killed and the coronary arteries were perfusion fixed. Serial sections were stained with H&E, WG, MT then evaluated by histopathologic and morphometric techniques. Intimal area (IA) and area of intimal thickness corrected for the extent of injury (INFL) was measured in the irradiated and control arteries and compared with pigs that underwent the same treatment but were followed for 2 weeks only.ResultsAll treated arteries were patent with normal angiographic appearance. Lumen diameters at baseline and follow-up were similar. There was no difference in fibrosis at the adventitia, media, perivascular space or adjacent segments of myocardium of the irradiated arteries compared with control.Control700 cGy1400 cGyIN/FL 2Weeks0.59±0.230.42±0.15**0.17±0.16****IN/FL 6 Months0.50±0.20.35±0.18*0.31±0.16**IA 6 Months (mm)1.25±0.250.85±0.47***0.62±0.45**P values: control versus treatment group:*P=0.009**P<0.001***P=0.05.****P<0.0001ConclusionsEndovascular low dose irradiation in this model is safe andthe inhibitory effect of localized radiation on neointimal thickening (restenos is like) response to angioplasty is maintained at six months