New AHA/ASA Stroke Guidelines Stress t-PA, Telemedicine

Telemedicine Comes of Age
If feasible, patients should be transported to the closest available certified primary care stroke center or comprehensive stroke center, which may involve air transport or hospital bypass.

An estimated 40% of Americans, however, live in remote or rural areas without direct access to a comprehensive stroke center. For these patients, the updated guidelines emphasize the use of telemedicine to extend expert stroke care and optimize the use of IV t-PA, said guideline coauthor Bart M. Demaerschalk, MD, Professor of Neurology at the Mayo Clinic in Phoenix.

“Even if air transport is available, the patients generally arrive when the respective treatment window is already closed,” he said. “So telemedicine often means the difference between no treatment whatsoever, which is the usual case, and treatment.”

The guidelines recommend teleradiology systems approved by the FDA or “an equivalent organization” for sites without in-house imaging expertise for prompt review of brain CT and MRI scans in patients with suspected acute stroke. When it is not physically possible for a stroke team physician to be at the bedside, telemedicine should also be established so that more hospitals can potentially meet the criteria to become acute stroke-ready hospitals and primary stroke hospitals.

Telemedicine may also be cost effective, according to a recent study coauthored by Dr. Demaerschalk. It reports that a telestroke network model with one hub and seven spoke hospitals would result in 45 more patients receiving IV thrombolysis and 20 more receiving endovascular stroke therapies per year, compared with usual care, and was associated with an estimated annual cost savings of $358,435 or $109,080 for each spoke hospital.