"Telestroke" centers aim to speed stroke care

Consulting a specialist for the treatment of ischemic stroke became easier over the years with the advent of telemedicine, according to several articles in the January Mayo Clinic Proceedings.

The technique has evolved into a lifesaving practice that deserves further attention, researchers wrote.

Telecommunications, which started with the telephone and advanced to the Internet and audiovisual techniques, has changed the face of medicine -- not only in remote areas but in urban centers where specialists may be in short supply.

A surge in the number of "telestroke" centers in the late 1990s and early 2000s resulted in 20 such networks being established across the U.S., Canada and Europe, stated Bart Demaerschalk, MD, associate professor of neurology at the Mayo Clinic in Scottsdale, Ariz., and colleagues.

"Stroke is the leading cause of death and disability in the United States," wrote Harold Adams Jr., MD, director of the division of cerebrovascular disorders at the University of Iowa Stroke Center in Iowa City. "The economic consequences of stroke, including health care costs and lost economic productivity, are substantial."

The need for rapid action is also imperative. "Each minute that an acute ischemic stroke goes untreated, 1.9 million neurons die," noted James F. Meschia, MD, a neurologist at the Mayo Clinic in Jacksonville, Fla., in an editorial.

Yet the three-hour treatment window often slips by. Sometimes it is because patients fail to arrive at hospitals in time, but it also is because physicians often are reluctant to give tissue plasminogen activator, Dr. Meschia said.

"Why the reticence for a proven therapy?" he asked. Physicians who are not vascular neurologists may perceive the risks of intracranial hemorrhage to be too high, he wrote. But specialists are more likely to appreciate the benefits of thrombolytic therapy for the right patients.

Getting the specialist to the patient's bedside is often impossible, but the reverse seems to work. Some locations transport stroke patients to special centers for treatment. But telestroke patients undergo a remote assessment at a hub hospital.

Obstacles to establishing such centers remain, wrote Dr. Demaerschalk and colleagues. Substantial investment in equipment and technical support is required, and obtaining reimbursement from insurers for such consultations is difficult. They recommended attention for solving such business issues to enable telestroke treatment to continue to grow.

The AMA has long encouraged the development of comprehensive practice standards and guidelines to address both the clinical and technological aspects of telemedicine.