Telestroke

IV recombinant tissue plasminogen activator (rtPA) within 4.5 hours of symptom onset has been established as an effective therapy for acute ischemic stroke.1 Over the past 2 decades, systems of care and quality assurance teams have developed to ensure that all potentially eligible patients receive IV rtPA in a timely and effective manner.2 Many neurologists cannot arrive rapidly to the emergency department for in-person acute stroke assessment, and many rural areas lack 24/7 coverage by neurologists. Telemedicine has brought neurologic expertise through real-time audiovisual technical link to the emergency department for assessment of patients within the narrow treatment window.3 Studies have shown that telemedicine (telestroke) is superior to a telephone (only) for acute stroke consultation and decision-making.4 Patient outcomes from telestroke administration of IV rtPA can rival outcomes from an in-person stroke team treatment.5 Multiple health economic analyses have demonstrated high cost-effectiveness for telestroke practice and likely cost savings from both the societal and hospital perspectives.6,7