The Telestroke solution to rural thrombolysis

More than fifteen years have passed since early intravenous thrombolysis was proven to improve functional outcome in acute ischaemic stroke. However, this effective treatment is still poorly utilised in rural areas where there is a shortage of stroke specialists required for safe thrombolysis. Due to long travel times from rural hospitals to stroke centres offering thrombolysis, rural patients often fail to present within the 4.5 hour eligibility window for thrombolysis. Furthermore, the delay in receiving thrombolysis is associated with more resultant disability, as time to treatment is critical in determining functional outcome. "Telestroke," the application of telemedicine in assessment and management of acute stroke patients, is one solution to combat the rural-metropolitan stroke care disparity. These systems utilise real-time videoconferencing technology to provide stroke specialist guidance for rural clinicians inexperienced in acute stroke care and increase rural accessibility of thrombolysis. Both site-dependent and mobile web-based Telestroke systems are already in place overseas and have demonstrated safety, diagnostic accuracy and improvement in long-term functional outcomes. In this paper, we describe the current progress of Telestroke in Australia, including a pilot mobile system successfully set up in rural Victoria.