Skip to main content

Advertisement

Log in

Telestroke

  • Stroke (JF Meschia, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This study aims to describe the current state of telestroke clinical applications and policies, in addition to key technical and operational aspects of the telemedicine practice.

Recent Findings

Delivery of telestroke services for neurovascular care expanded from the intravenous alteplase decision and administration in acute emergency department settings to a continuum of services in mobile and inpatient stroke units, intensive care units, virtual stroke clinics, rehabilitation, and clinical research. Telestroke cost-effectiveness is well established from multiple perspectives. Stroke centers, certification agencies, and national registries have made essential recommendations regarding telestroke quality measures monitoring and reporting.

Summary

Telestroke continues to bring neurovascular expertise to resource-restricted areas with advanced virtual communication techniques, optimizing stroke care. Future research should aim at broadening telestroke technology applications, while improving quality and reducing the delivery-associated cost and resources. Comprehensive multidisciplinary virtual telestroke centers that cover all aspects of stroke management might become available in the future.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Demaerschalk BM, Berg J, Chong BW, Gross H, Nystrom K, Adeoye O, et al. American Telemedicine Association: telestroke guidelines. Telemed J E Health. 2017;23(5):376–89. This policy study provides detailed guidelines for telestroke services.

    Article  PubMed  Google Scholar 

  2. • Blacquiere D, Lindsay MP, Foley N, Taralson C, Alcock S, Balg C, et al. Canadian Stroke Best Practice Recommendations: Telestroke Best Practice Guidelines Update 2017. Int J Stroke. 2017:1747493017706239. This study is a comprehensive summary of the current evidence-based and consensus-based recommendations for telestroke best practice.

  3. Mutgi SA, Zha AM, Behrouz R. Emerging subspecialties in neurology: telestroke and teleneurology. Neurology. 2015;84(22):e191–3.

    Article  PubMed  Google Scholar 

  4. Krishnamurthi RV, Moran AE, Feigin VL, Barker-Collo S, Norrving B, Mensah GA, et al. Stroke prevalence, mortality and disability-adjusted life years in adults aged 20–64 years in 1990–2013: data from the global burden of disease 2013 study. Neuroepidemiology. 2015;45(3):190–202.

    Article  PubMed  Google Scholar 

  5. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med. 2016;375(2):154–61.

    Article  PubMed  Google Scholar 

  6. Amorim E, Shih MM, Koehler SA, Massaro LL, Zaidi SF, Jumaa MA, et al. Impact of telemedicine implementation in thrombolytic use for acute ischemic stroke: the University of Pittsburgh Medical Center telestroke network experience. J Stroke Cerebrovasc Dis. 2013;22(4):527–31.

    Article  PubMed  Google Scholar 

  7. Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947.

    Article  PubMed  Google Scholar 

  8. Meyer BC, Raman R, Hemmen T, Obler R, Zivin JA, Rao R, et al. Efficacy of site-independent telemedicine in the STRokE DOC trial: a randomised, blinded, prospective study. Lancet Neurol. 2008;7(9):787–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Agrawal K, Raman R, Ernstrom K, Claycomb RJ, Meyer DM, Hemmen TM, et al. Accuracy of stroke diagnosis in telestroke-guided tissue plasminogen activator patients. J Stroke Cerebrovasc Dis. 2016;25(12):2942–6.

    Article  PubMed  Google Scholar 

  10. Demaerschalk BM, Bobrow BJ, Raman R, Ernstrom K, Hoxworth JM, Patel AC, et al. CT interpretation in a telestroke network: agreement among a spoke radiologist, hub vascular neurologist, and hub neuroradiologist. Stroke. 2012;43(11):3095–7.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Muller-Barna P, Hubert GJ, Boy S, Bogdahn U, Wiedmann S, Heuschmann PU, et al. TeleStroke units serving as a model of care in rural areas: 10-year experience of the TeleMedical project for integrative stroke care. Stroke. 2014;45(9):2739–44.

    Article  PubMed  Google Scholar 

  12. Audebert HJ, Wimmer ML, Hahn R, Schenkel J, Bogdahn U, Horn M, et al. Can telemedicine contribute to fulfill WHO Helsingborg declaration of specialized stroke care? Cerebrovasc Dis. 2005;20(5):362–9.

    Article  PubMed  Google Scholar 

  13. Sanders KA, Patel R, Kiely JM, Gwynn MW, Johnston LH. Improving telestroke treatment times in an expanding network of hospitals. J Stroke Cerebrovasc Dis. 2016;25(2):288–91.

    Article  PubMed  Google Scholar 

  14. Audebert HJ, Kukla C, Clarmann von Claranau S, Kuhn J, Vatankhah B, Schenkel J, et al. Telemedicine for safe and extended use of thrombolysis in stroke: the Telemedic pilot project for integrative stroke care (TEMPiS) in Bavaria. Stroke. 2005;36(2):287–91.

    Article  CAS  PubMed  Google Scholar 

  15. Hubert GJ, Meretoja A, Audebert HJ, Tatlisumak T, Zeman F, Boy S, et al. Stroke thrombolysis in a centralized and a decentralized system (Helsinki and Telemedical project for integrative stroke care network). Stroke. 2016;47(12):2999–3004.

    Article  PubMed  Google Scholar 

  16. Schwamm LH, Holloway RG, Amarenco P, Audebert HJ, Bakas T, Chumbler NR, et al. A review of the evidence for the use of telemedicine within stroke systems of care: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2009;40(7):2616–34.

    Article  PubMed  Google Scholar 

  17. Schwab S, Vatankhah B, Kukla C, Hauchwitz M, Bogdahn U, Furst A, et al. Long-term outcome after thrombolysis in telemedical stroke care. Neurology. 2007;69(9):898–903.

    Article  CAS  PubMed  Google Scholar 

  18. Wang S, Lee SB, Pardue C, Ramsingh D, Waller J, Gross H, et al. Remote evaluation of acute ischemic stroke: reliability of National Institutes of Health stroke scale via telestroke. Stroke. 2003;34(10):e188–91.

    Article  PubMed  Google Scholar 

  19. Demaerschalk BM, Vegunta S, Vargas BB, Wu Q, Channer DD, Hentz JG. Reliability of real-time video smartphone for assessing National Institutes of Health stroke scale scores in acute stroke patients. Stroke. 2012;43(12):3271–7.

    Article  PubMed  Google Scholar 

  20. Puetz V, Bodechtel U, Gerber JC, Dzialowski I, Kunz A, Wolz M, et al. Reliability of brain CT evaluation by stroke neurologists in telemedicine. Neurology. 2013;80(4):332–8.

    Article  PubMed  Google Scholar 

  21. Mitchell JR, Sharma P, Modi J, Simpson M, Thomas M, Hill MD, et al. A smartphone client-server teleradiology system for primary diagnosis of acute stroke. J Med Internet Res. 2011;13(2):e31.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Pexman JH, Barber PA, Hill MD, Sevick RJ, Demchuk AM, Hudon ME, et al. Use of the Alberta stroke program early CT score (ASPECTS) for assessing CT scans in patients with acute stroke. AJNR Am J Neuroradiol. 2001;22(8):1534–42.

    CAS  PubMed  Google Scholar 

  23. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10029):1723–31.

    Article  PubMed  Google Scholar 

  24. Smith EE, Schwamm LH. Endovascular clot retrieval therapy: implications for the organization of stroke systems of care in North America. Stroke. 2015;46(6):1462–7.

    Article  CAS  PubMed  Google Scholar 

  25. Pedragosa A, Alvarez-Sabin J, Rubiera M, Rodriguez-Luna D, Maisterra O, Molina C, et al. Impact of telemedicine on acute management of stroke patients undergoing endovascular procedures. Cerebrovasc Dis. 2012;34(5–6):436–42.

    Article  CAS  PubMed  Google Scholar 

  26. Kepplinger J, Dzialowski I, Barlinn K, Puetz V, Wojciechowski C, Schneider H, et al. Emergency transfer of acute stroke patients within the east Saxony telemedicine stroke network: a descriptive analysis. Int J Stroke. 2014;9(2):160–5.

    Article  PubMed  Google Scholar 

  27. Barlinn J, Gerber J, Barlinn K, Pallesen LP, Siepmann T, Zerna C, et al. Acute endovascular treatment delivery to ischemic stroke patients transferred within a telestroke network: a retrospective observational study. Int J Stroke. 2016.

  28. •• Wechsler LR, Demaerschalk BM, Schwamm LH, Adeoye OM, Audebert HJ, Fanale CV, et al. Telemedicine quality and outcomes in stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017;48(1):e3–e25. This study provides the current status of the quality and outcomes in telestroke networks.

    Article  PubMed  Google Scholar 

  29. Backhaus R, Schlachetzki F, Rackl W, Baldaranov D, Leitzmann M, Hubert GJ, et al. Intracranial hemorrhage: frequency, location, and risk factors identified in a TeleStroke network. Neuroreport. 2015;26(2):81–7.

    Article  PubMed  Google Scholar 

  30. Yaghi S, Rayaz S, Bianchi N, Hall-Barrow JC, Hinduja A. Thrombolysis to stroke mimics in telestroke. J Telemed Telecare. 2012.

  31. Ali SF, Viswanathan A, Singhal AB, Rost NS, Forducey PG, Davis LW, et al. The TeleStroke mimic (TM)-score: a prediction rule for identifying stroke mimics evaluated in a Telestroke network. J Am Heart Assoc. 2014;3(3):e000838.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Mackay MT, Churilov L, Donnan GA, Babl FE, Monagle P. Performance of bedside stroke recognition tools in discriminating childhood stroke from mimics. Neurology. 2016;86(23):2154–61.

    Article  PubMed  Google Scholar 

  33. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous Alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581–641.

    Article  PubMed  Google Scholar 

  34. Van Hooff RJ, Cambron M, Van Dyck R, De Smedt A, Moens M, Espinoza AV, et al. Prehospital unassisted assessment of stroke severity using telemedicine: a feasibility study. Stroke. 2013;44(10):2907–9.

    Article  PubMed  Google Scholar 

  35. Walter S, Kostopoulos P, Haass A, Keller I, Lesmeister M, Schlechtriemen T, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 2012;11(5):397–404.

    Article  PubMed  Google Scholar 

  36. Kunz A, Ebinger M, Geisler F, Rozanski M, Waldschmidt C, Weber JE, et al. Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study. Lancet Neurol. 2016;15(10):1035–43.

    Article  PubMed  Google Scholar 

  37. Ebinger M, Kunz A, Wendt M, Rozanski M, Winter B, Waldschmidt C, et al. Effects of golden hour thrombolysis: a Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke (PHANTOM-S) substudy. JAMA Neurol. 2015;72(1):25–30.

    Article  PubMed  Google Scholar 

  38. Wu TC, Parker SA, Jagolino A, Yamal JM, Bowry R, Thomas A, et al. Telemedicine can replace the neurologist on a mobile stroke unit. Stroke. 2017;48(2):493–6.

    Article  PubMed  Google Scholar 

  39. Vespa PM, Miller C, Hu X, Nenov V, Buxey F, Martin NA. Intensive care unit robotic telepresence facilitates rapid physician response to unstable patients and decreased cost in neurointensive care. Surg Neurol. 2007;67(4):331–7.

    Article  PubMed  Google Scholar 

  40. Klein KE, Rasmussen PA, Winners SL, Frontera JA. Teleneurocritical care and telestroke. Crit Care Clin. 2015;31(2):197–224.

    Article  PubMed  Google Scholar 

  41. Laver KE, Schoene D, Crotty M, George S, Lannin NA, Sherrington C. Telerehabilitation services for stroke. Cochrane Database Syst Rev. 2013;12:CD010255.

    Google Scholar 

  42. Chen J, Jin W, Zhang XX, Xu W, Liu XN, Ren CC. Telerehabilitation approaches for stroke patients: systematic review and meta-analysis of randomized controlled trials. J Stroke Cerebrovasc Dis. 2015;24(12):2660–8.

    Article  PubMed  Google Scholar 

  43. Rubin MN, Barrett KM, Freeman WD, Lee Iannotti JK, Channer DD, Rabinstein AA, et al. Teleneurosonology: a novel application of transcranial and carotid ultrasound. J Stroke Cerebrovasc Dis. 2015;24(3):562–5.

    Article  PubMed  Google Scholar 

  44. Switzer JA, Hall CE, Close B, Nichols FT, Gross H, Bruno A, et al. A telestroke network enhances recruitment into acute stroke clinical trials. Stroke. 2010;41(3):566–9.

    Article  PubMed  Google Scholar 

  45. Lin MP, Sanossian N, Liebeskind DS. Imaging of prehospital stroke therapeutics. Expert Rev Cardiovasc Ther. 2015;13(9):1001–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Kramer NM, Demaerschalk BM. A novel application of teleneurology: robotic telepresence in supervision of neurology trainees. Telemed J E Health. 2014;20(12):1087–92.

    Article  PubMed  Google Scholar 

  47. Jagolino AL, Jia J, Gildersleeve K, Ankrom C, Cai C, Rahbar M, et al. A call for formal telemedicine training during stroke fellowship. Neurology. 2016;86(19):1827–33.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Richard S, Mione G, Varoqui C, Vezain A, Brunner A, Bracard S, et al. Simulation training for emergency teams to manage acute ischemic stroke by telemedicine. Medicine (Baltimore). 2016;95(24):e3924.

    Article  Google Scholar 

  49. Rafter RH, Kelly TM. Nursing implementation of a telestroke programme in a community hospital in the US. J Nurs Manag. 2011;19(2):193–200.

    Article  PubMed  Google Scholar 

  50. Hess DC, Audebert HJ. The history and future of telestroke. Nat Rev Neurol. 2013;9(6):340–50.

    Article  PubMed  Google Scholar 

  51. Audebert H. Telestroke: effective networking. Lancet Neurol. 2006;5(3):279–82.

    Article  PubMed  Google Scholar 

  52. Schwamm LH, Audebert HJ, Amarenco P, Chumbler NR, Frankel MR, George MG, et al. Recommendations for the implementation of telemedicine within stroke systems of care: a policy statement from the American Heart Association. Stroke. 2009;40(7):2635–60.

    Article  PubMed  Google Scholar 

  53. Rogove HJ, McArthur D, Demaerschalk BM, Vespa PM. Barriers to telemedicine: survey of current users in acute care units. Telemed J E Health. 2012;18(1):48–53.

    Article  PubMed  Google Scholar 

  54. Kulcsar M, Gilchrist S, George MG. Improving stroke outcomes in rural areas through telestroke programs: an examination of barriers, facilitators, and state policies. Telemed J E Health. 2014;20(1):3–10.

    Article  PubMed  Google Scholar 

  55. Switzer JA, Demaerschalk BM, Xie J, Fan L, Villa KF, Wu EQ. Cost-effectiveness of hub-and-spoke telestroke networks for the management of acute ischemic stroke from the hospitals’ perspectives. Circ Cardiovasc Qual Outcomes. 2013;6(1):18–26.

    Article  PubMed  Google Scholar 

  56. Nelson RE, Okon N, Lesko AC, Majersik JJ, Bhatt A, Baraban E. The cost-effectiveness of telestroke in the Pacific northwest region of the USA. J Telemed Telecare. 2016;22(7):413–21.

    Article  PubMed  Google Scholar 

  57. Demaerschalk BM, Switzer JA, Xie J, Fan L, Villa KF, Wu EQ. Cost utility of hub-and-spoke telestroke networks from societal perspective. Am J Manag Care. 2013;19(12):976–85.

    PubMed  Google Scholar 

  58. Sharma S, Padma MV, Bhardwaj A, Sharma A, Sawal N, Thakur S. Telestroke in resource-poor developing country model. Neurol India. 2016;64(5):934–40.

    Article  PubMed  Google Scholar 

  59. Lippman JM, Smith SN, McMurry TL, Sutton ZG, Gunnell BS, Cote J, et al. Mobile Telestroke during ambulance transport is feasible in a rural EMS setting: the iTREAT study. Telemed J E Health. 2016;22(6):507–13.

    Article  PubMed  Google Scholar 

  60. Gyrd-Hansen D, Olsen KR, Bollweg K, Kronborg C, Ebinger M, Audebert HJ. Cost-effectiveness estimate of prehospital thrombolysis: results of the PHANTOM-S study. Neurology. 2015;84(11):1090–7.

    Article  PubMed  Google Scholar 

  61. Belt GH, Felberg RA, Rubin J, Halperin JJ. In-transit telemedicine speeds ischemic stroke treatment: preliminary results. Stroke. 2016;47(9):2413–5.

    Article  PubMed  Google Scholar 

  62. Demaerschalk BM. Seamless integrated stroke telemedicine systems of care: a potential solution for acute stroke care delivery delays and inefficiencies. Stroke. 2011;42(6):1507–8.

    Article  PubMed  Google Scholar 

  63. Shuaib A, Khan K, Whittaker T, Amlani S, Crumley P. Introduction of portable computed tomography scanners, in the treatment of acute stroke patients via telemedicine in remote communities. Int J Stroke. 2010;5(2):62–6.

    Article  CAS  PubMed  Google Scholar 

  64. Demeestere J, Sewell C, Rudd J, Ang T, Jordan L, Wills J, et al. The establishment of a telestroke service using multimodal CT imaging decision assistance: “turning on the fog lights”. J Clin Neurosci. 2017;37:1–5.

    Article  PubMed  Google Scholar 

  65. Muller-Barna P, Audebert HJ. High-standard TeleStroke: need for experienced stroke experts trained in imaging interpretation. Neurology. 2013;80(4):326–7.

    Article  PubMed  Google Scholar 

  66. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98–e169.

    Article  PubMed  Google Scholar 

  67. Malandraki GA, McCullough G, He X, McWeeny E, Perlman AL. Teledynamic evaluation of oropharyngeal swallowing. J Speech Lang Hear Res. 2011;54(6):1497–505.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Rubin MN, Wellik KE, Channer DD, Demaerschalk BM. Systematic review of telestroke for post-stroke care and rehabilitation. Curr Atheroscler Rep. 2013;15(8):343.

    Article  PubMed  Google Scholar 

  69. Alberts MJ, Latchaw RE, Selman WR, Shephard T, Hadley MN, Brass LM, et al. Recommendations for comprehensive stroke centers: a consensus statement from the brain attack coalition. Stroke. 2005;36(7):1597–616.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Oana M. Dumitrascu.

Ethics declarations

Conflict of Interest

O.M.D. and B.M.D. declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Stroke

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dumitrascu, O.M., Demaerschalk, B.M. Telestroke. Curr Cardiol Rep 19, 85 (2017). https://doi.org/10.1007/s11886-017-0895-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-017-0895-1

Keywords

Navigation