4 The Promise of Telestroke

Benzion Blech and Bart M. Demaerschalk

Abstract

This chapter describes telestroke in its current state, including clinical applications, policies, guidelines, and technical and operational aspects of the telemedicine practice. Telestroke has expanded from the early diagnosis of stroke and delivery of intravenous alteplase in rural emergency department settings to involve a continuum of neurovascular services in mobile stroke units, intensive care units, medical-surgical wards, rehabilitation facilities, ambulatory stroke prevention clinics, patient homes, and in clinical research units. Great strides have been made in the development and innovation regarding the technologies used in the telestroke practice. Health economic analyses of telestroke report cost-effectiveness from multiple payer perspectives. Monitoring and reporting of quality measures related to telestroke are prerequisites for stroke center accreditation and certification. Telestroke continues to bring neurovascular expertise to underserviced areas with advanced virtual telecommunication technologies, optimizing regional stroke care delivery. Future research may investigate whether comprehensive and multidisciplinary virtual telestroke centers could cover all aspects of stroke management, from prehospital acute care to reintegration into the community and beyond.

Key words

telestroke - telemedicine - alteplase - acute ischemic stroke - thrombectomy - teleneurology

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