Perspectives on telemedicine to improve stroke treatment.

Stroke is the number three cause of death and the most common cause of adult disability in the United States. Few patients receive the only established effective therapy, intravenous tissue plasminogen activator. Failure to treat may occur due to several reasons, a crucial one being the lack of acute neurologic coverage, particularly in rural settings. In this article we review the difficulties encountered by patients needing immediate care to access stroke specialists. To overcome this delay in patient care, telemedicine technology for acute stroke care is recommended. We track the emergence and evolution of "telestroke" from initial telephone consultation, to point-to-point, hub-and-spoke networks, to web-based site-independent telestroke systems. We detail the emerging evidence for the safety and efficacy of these remote telestroke systems through observational studies (TEMPiS and REACH). Lastly, we discuss areas where telestroke could potentially expand to provide more complete stroke care beyond the acute thrombolysis phase, as well as its potential to improve clinical research and the need for cost-effective research. We conclude that telestroke is currently the most practical solution to any setback faced by stroke specialists with respect to low thrombolytic rates.