Sharing Stroke Expertise From Miles Away

By James Conners, MD

Stroke is the third leading cause of death in the United States and the leading cause of disability. Ischemic stroke is defined as a sudden loss of brain function caused by the blockage of a blood vessel leading to inadequate blood supply to the brain.

Each minute of an untreated stroke, 1.9 million neurons die. We now have multiple methods to treat acute ischemic strokes, but time is of the essence and treatments need to be initiated as soon as possible.

One specific treatment is intravenous thrombolysis with tissue plasminogen activator (t-PA), a “clot busting” drug. This clot-busting drug can greatly reduce the disability resulting from a stroke but must be administered within 4.5 hours of stroke onset. Unfortunately only a small number of potentially eligible stroke patients currently receive t-PA. One major reason for this is that many patients fail to arrive at the hospital in time. However, delay in assessment by a stroke specialist often plays a role as well.

Neurologists, and especially stroke specialists known as vascular neurologists, play a crucial role in the assessment and treatment of stroke patients. The majority of hospitals do not have neurologists on site 24 hours a day. The time that it takes to be assessed by a neurologist is one of the major limiting factors in the treatment of acute stroke. This has led to the advent of telemedicine, which establishes a link between clinicians at different locations using advanced videoconferencing and imaging technology. This allows vascular neurologists at Rush to share their expertise even though they are miles away.

Here is how it works: As soon as a stroke patient arrives in the emergency room, a telemedicine consultation is initiated, establishing a real-time telecommunications link between the local emergency department staff and a stroke specialist at Rush. Videoconferencing capability gives the neurologist the added benefit of seeing and talking to the patient face-to-face. The neurologist is able to examine the patient and review radiologic imaging which aids in a quick and accurate diagnosis.

With telemedicine, doctors can rapidly diagnose stroke patients at remote locations and recommend a plan of care that could lead to improved patient outcomes. To bring Rush’s stroke expertise to more patients in the Chicago area, Rush’s stroke team — which comprises vascular neurologists, neurointerventionalists, neurosurgeons and neurointensivists — is establishing telemedicine links with community hospitals in the city and suburbs.

James J. Conners, MD, MS, is an assistant professor in the Department of Neurological Sciences at Rush University Medical Center.

Related resources:

Stroke treatment Chicago

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