Development of regional programs to speed treatment of stroke

The pathophysiology of ischemic stroke dictates that treatments be administered shortly after symptom onset to be beneficial. Intravenous tissue plasminogen activator is the only drug proven to be effective in stroke; it is approved for administration within a 3-hour window. To optimize the number of potential candidates for thrombolytic therapy, patients and families must understand the symptoms and signs of stroke and how to respond. Emergency medical services and emergency departments also must be prepared for rapid evaluation to determine if a patient is appropriate for reperfusion therapy. Due to a lack of stroke specialists in many communities, some hospitals may not be prepared to provide intravenous thrombolytic therapy around the clock, and time lost transporting patients to tertiary centers may mitigate the benefits of thrombolysis. Telestroke may be the best alternative in this scenario, extending acute stroke therapies to patients who would otherwise not receive treatment.