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Telestroke permits time-sensitive acute stroke consultations to remote Emergency Departments (ED) regardless of distance.1 Time is the critical issue in acute stroke, where minutes matter. The odds of an excellent 3-month outcome decline with every minute before tissue plasminogen activator (tPA) is administered.2 In this issue of Neurology®, Sairanen and colleagues3 describe how “hub” consultants provided telestroke coverage to remote Finnish “spoke” hospitals 80–500 miles away, to help decide whether to administer tPA. They showed that the 3-month functional outcomes and symptomatic intracranial bleeding rate in tPA-treated spoke patients were similar to those treated in person at the hub.
More than half of spoke consultations resulted in the administration of IV tPA, a higher percentage than observed in other studies, where only about a quarter are treated.4 This may be due to “spot coverage.” The 29 consultants provided less than 24-hour coverage; during the regular day shift, tPA was administered by local neurologists so that the ED staff was experienced. It is likely, then, that experienced ED teams' consultations were more likely to result in tPA administration. The consultations took about 23 minutes and the median onset to treatment time was about 120 minutes, further evidence that telestroke consultations lead to early treatment.4 All patients remained in the spoke hospitals …
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