Abstract
Intravenous recombinant tissue plasminogen activator is the only medication approved by the US Food and Drug Administration for treatment of acute stoke. Despite established efficacy, less than 3% of stroke patients receive treatment, and that number is even smaller for patients living in remote locations. This is in part due to a lack of neurologists and stroke specialists in these rural communities. The traditional model of "ship and drip" wastes crucial time, resulting in delays or loss of treatment. In this review, we discuss strategies to overcome geographic disparities in stroke care and improve acute treatment in remote locations. Helicopter transport from field to stroke center is one option to rapidly deliver patients to stroke centers. However, geography, weather, and unnecessary transport are potential drawbacks. Alternatively, "telestroke" facilitates remote evaluation of acute stroke patients via an audiovisual link and transmission of computerized tomography images. Despite the physical separation, stroke specialists are able to examine patients, review brain imaging and make correct treatment decisions; transfer to a stroke center can then be performed as appropriate. A cost-benefit analysis of telestroke is needed, although the recent proliferation of telestroke networks suggests an economic asset to some hospital systems.