AcuteCare Telemedicine Blog


Expanding tPA Stroke Treatment Through Telestroke Delivery Model

For years, the mantra of neurologists treating stroke victims has been “time equals brain.” That’s because getting a patient to the emergency room quickly to receive a drug that dissolves the stroke-causing blood clot can make a significant difference in how much brain tissue is saved or lost. Established research has demonstrated that administering a tissue plasminogen activator (tPA) intravenously up to 4.5 hours, after the onset of a stroke, benefits patients with moderate to severe acute ischemic stroke. An ischemic stroke occurs as a result of an obstruction within a blood vessel supplying blood to the brain and it accounts for 87 percent of all stroke cases.

While the use of tPA significantly improves a patients recovery from stroke its administration requires the availability of neurologic expertise within this narrow window of time.  Specialized stroke care at large academic medical facilities is very effective in providing stroke care but access to these centers is limited to patients living in rural areas of the country.  Practiced-based telestroke services, staffed primarily by general neurologist, offer a streamlined organization that facilitates the dissemination of this vital emergency treatment but a comparative analysis of the data between the two delivery systems is a critical.

“Expanding Access to Intravenous Tissue-type Plasminogen Activator with a Practiced-based Telestroke System” was recently published by the Journal of Stroke and Cerebrovascular Diseases.  The study was prepared by 4 practiced-based neurologists at AcuteCare Telemedicine (ACT), an Atlanta-based company that’s billed as the largest practice-based provider of teleneurology in the southeast.  Summary findings included data gathered over a two year period at 7 hospitals on 202 emergency telemedicine consultations and treatment of 54 telestroke patients with IV tPA.  Patient demographics and outcome measures were not significantly different for patients treated by practiced–based or academic providers with the exception of lower age and shorter stay duration of the practiced-based treatment group.

The results indicate that emergency stroke care provided by the two delivery models can achieve similar patient outcomes and that a practiced-based telestroke system can expand the availability of IV tPA treatment with clinical outcomes no different from previously published studies.

“Meeting the requirement of providing rapid neurology care to all of the nation’s emergency rooms will necessitate a concerted effort of academic and practiced-based stroke systems”, said Dr. Keith A Sanders, ACT.  The technological, organizational and financial hurdles which currently limit telestroke use and expansion will likely be resolved as the benefits of telemedicine become more evident with its expanded use.

For more study details and the full article, contact info@acutecaretelemed.com


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