Telestroke and Neurocritical Care

This chapter describes telestroke in its current state, including clinical applications, policies, guidelines, technical, and operational aspects of the telemedicine practice. Telestroke has expanded from early diagnosis to delivery of intravenous alteplase in rural emergency department settings, to involve a continuum of neurovascular services in mobile stroke units, intensive care units, medical-surgical wards, rehabilitation facilities, ambulatory stroke prevention clinics, patients’ homes, and in clinical research units. Health economic analyses of telestroke report cost-effectiveness from multiple payer perspectives. Monitoring and reporting of quality measures related to telestroke are prerequisites for stroke center accreditation and certification. Telestroke continues to bring neurovascular expertise to underserviced areas with advanced virtual telecommunication technologies, optimizing regional stroke care delivery. Future research may investigate whether comprehensive multidisciplinary seamless virtual telestroke centers could cover all aspects of stroke management from prehospital to acute care to reintegration into the community and beyond.