Availability of TeleNeurology and TeleNeurosurgery Consultations Could Optimize Use of Effective Intervention for Patients With Acute Ischemic Strokes

On-demand access to both teleNeurologists and teleNeurosurgeons could optimize the use of effective intervention with IV thrombolytics for patients experiencing an acute ischemic stroke in two ways:

  1. Providing timely expert specialty consultation to emergency department teams to appropriately diagnose an acute ischemic stroke and administer thrombolytics, if indicated.
  2. Overcoming hesitancy to keep post-thrombolytic patients in the local hospital due to the accompanying risks of its use, including intracranial bleed, and the potential need for neurosurgical evaluation.
Neurologist analyzing a brain scan on two computer screens
Telehealth cart with a telemedicine specialist on the screen ready to provide care.

Despite proven effectiveness, use of IV thrombolytics for experiencing an acute ischemic stroke is not always consistent due to factors such as stroke recognition, the patient’s medical history, or timing of presentation to a hospital. Fewer than 4 percent of patients with acute ischemic stroke received thrombolytics in 2013; by 2017 the proportion had increased only to between 12 percent and 18 percent, depending on the age of the patient.

Clinical guidelines from the American Stroke Association strongly recommend intravenous administration of thrombolytics in appropriate stroke settings. Patients receiving IV thrombolytics are almost twice as likely to have a favorable outcome, according to the American Stroke Association.

Ways that local hospitals experience barriers related to IV thrombolytic use:

Lack of neurology coverage: Not every hospital or emergency department has access to a neurologist who can determine the type of stroke – ischemic or hemorrhagic – and who can promptly direct administration of the intravenous thrombolytic and post-thrombolytic care. The shortage of neurologists nationwide is well-documented and is particularly acute in rural areas, leaving many communities with no access to emergency neurological expertise in the event of a stroke.

Access TeleCare’s teleNeurology programs work with hospitals of all sizes to ensure 24/7 neurology coverage through telemedicine.

Neurologist discussing the results of a brain x-ray with the patient

Clinician concern about post-thrombolytic complications: Even after direct consultation with a neurologist, clinicians may remain reluctant to admit patients locally after the administration of IV thrombolytics due to the potential risk of bleeding that can accompany its use and often instead prefer to transfer the patient to a higher level of care for access to a neurosurgeon should surgical intervention be required in the event of an acute intracranial bleed. This reluctance persists despite research showing that neurosurgery following administration of IV thrombolytics is low, according to research published in the Journal of Stroke and Cerebrovascular Diseases.

Dr. Annie Tsui
Chief of Neurology | Access TeleCare

“Access TeleCare is pioneering the use of teleNeurosurgery consultations, building on its legacy of leadership in telemedicine and its large teleNeurology footprint.

The addition of on-demand teleNeurosurgery consultations is the next step in building and deploying clinical programs that address the full continuum of neurological care  for hospitals of all sizes and improving access to specialty care for patients experiencing a stroke, no matter where they live.”

Access TeleCare teleNeurosurgery programs can help hospitals appropriately reduce outbound transfers of patients experiencing an acute ischemic stroke. Having a teleNeurosurgeon who can consult with the patient, neurologist (either in person or remote), and on-site clinicians and delineate likelihood of the need for surgical intervention can help on-site teams feel more confident about appropriately keeping post-thrombolytic patients in their local communities of care and home support networks.

For more information about teleNeurology and teleNeurosurgery with Access TeleCare, visit

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