TELESTROKE: EXPANDING ACUTE STROKE CARE TO UNDERSERVED AREAS

Telestroke is a relatively new and rapidly growing technology that allows underserved hospitals and communities to receive the expertise of a vascular neurologist using video and audio services. Prior to the concept of telestroke, tPA treatment rates for eligible patients were low. The advent of telestroke has helped reach these eligible patients for whom acute treatment may have previously been restricted due to a variety of reasons, including lack of familiarity with tPA indications and contraindications, immediate stroke expertise availability, and time constraints. There is evidence that telestroke assessments are safe, reliable, and effective for appropriately treating acute stroke patients, in addition to being cost-effective. Telestroke is now an important component of the American Heart Association/American Stroke Association 2019 Guidelines for the Early Management of Patients with Acute Ischemic Stroke. In this chapter, we will review the historical indications that provided the groundwork for telestroke, summarize the evidence for the efficacy and safety of telestroke, and describe the various models of telestroke that are currently being employed.