Principles and practice of thrombolysis via telestroke

Despite developments in acute stroke therapies, stroke continues to be a leading cause of death and disability worldwide. One major limitation from intravenous thrombolysis with tissue plasminogen activator (t-PA) is patient`s arrival to the emergency room at a tertiary care hospital after the therapeutic time-window, which is generally 270 minutes. The problem is worse for people living in suburban areas where stroke expertise can be missing. Therefore, telestroke networks were developed at several sites where a stroke neurologist at a tertiary hospital participates through synchronous audio-video teleconference in confirming diagnosis of stroke, assessing risks and benefits of giving IV t-PA, and making the decision with the patient and emergency physician at the local hospital. In this article, we will review the experience of major telestroke networks in North America and Europe, and the evidence of its safety and cost-effectiveness. Telestroke complexity, with regard to practice, manpower, quality assurance, and legal issues will be discussed briefly.