Intravenous Tissue Plasminogen Activator Administration in Community Hospitals Facilitated by Telestroke Service BACKGROUND: Stroke is a leading cause of death and disability in the United States. Despite the proven benefits of intravenous tissue plasminogen activator (IV-tPA), only a small percentage of patients who have had a stroke (3.4%–5.2%) receive this US Food and Drug Administration-approved therapy. OBJECTIVE: To prospectively assess the impact of a telestroke network on the rate of IV-tPA administration in patients with acute ischemic stroke in community hospitals. METHODS: Thomas Jefferson University Hospital has developed a telestroke system providing acute stroke care in 28 community hospitals within the region (Pennsylvania, New Jersey, and Delaware). Telemedicine consultations are delivered through Remote Presence robotic technology. RESULTS: A total of 1643 telemedicine stroke consultations were provided between January 2011 and June 2012. The mean interval from consultation request to telemedicine response was 12.0 minutes. The overall rate of IV-tPA use was 14% among all stroke consultations. A total of 237 patients (14.4%) were determined to be eligible for intrave- nous thrombolysis. Of those, 97% received IV-tPA. Most hospitals (82%) within the tele- medicine program reported an increase in IV-tPA use (mean increase, 55%). The proportion of patients transferred to a primary stroke center after teleconsultation decreased from 44% in the first 2 quarters of 2011 to 19% in the first 2 quarters of 2012 (P , .001). CONCLUSION: Implementing a telestroke system facilitates high rates of intravenous thrombolysis in patients who have had a stroke in community hospitals within a rela- tively short time frame. These results are higher than the national average rate (3.4%– 5.2%) and support the implementation of telestroke networks for wider access to stroke expertise in underserved regions. KEY WORDS: Stroke, Telemedicine, Telestroke, Thrombolysis Neurosurgery 73:667–672, 2013 DOI: 10.1227/NEU.0000000000000073 www.neurosurgery-online.com S troke is the fourth leading cause of death in the United States and the main cause of long- term adult disability. The financial burden to society has been estimated to reach more than $30 billion annually for direct and indirect stroke- related costs in the United States. 1 Thus, successful management of acute ischemic stroke (AIS) has vast public health implications. The main treat- ment objective for AIS is prompt restoration of blood flow, because early revascularization has the highest potential for neurological improvement. 2 Intravenous tissue plasminogen activator (IV-tPA) is the only US Food and Drug Administration- approved medical therapy for AIS and can be administered within a 3-hour window from symptom onset. 3 Current stroke guidelines have extended the therapeutic IV-tPA administration window to 4.5 hours for a select group of patients. 4 Despite its proven benefit, only 3% to 5% of AIS patients are actually treated with IV-tPA. 5 The major reason patients do not receive thrombolytic therapy is arrival at a stroke center beyond the therapeutic window. Other obstacles to IV-tPA administration include the lack of local stroke expertise, poor community awareness of stroke symptoms, long distance to primary stroke centers, and physician reluctance to order the medication Nohra Chalouhi, MD Jeremy A. Dressler, BS Emily S.I. Kunkel Richard Dalyai, MD Pascal Jabbour, MD L. Fernando Gonzalez, MD Robert M. Starke, MD Aaron S. Dumont, MD Robert Rosenwasser, MD Stavropoula Tjoumakaris, MD Department of Neurosurgery, Thomas Jefferson University and Jefferson Hos- pital for Neuroscience, Philadelphia, Pennsylvania Correspondence: Stavropoula I. Tjoumakaris, MD, Assistant Professor, Department of Neurological Surgery, Division of Neurovascular Surgery and, Endovascular Neurosurgery, Thomas Jefferson University Hospital, 901 Walnut St, 3rd Floor, Philadelphia, PA 19107. E-mail: stavropoula. tjoumakaris@jefferson.edu Received, February 9, 2013. Accepted, June 24, 2013. Published Online, July 9, 2013. Copyright ª 2013 by the Congress of Neurological Surgeons ABBREVIATIONS: AIS, acute ischemic stroke; ED, emergency department; IV-tPA, intravenous tissue plasminogen activator RESEARCH—HUMAN—CLINICAL STUDIES TOPIC RESEARCH—HUMAN—CLINICAL STUDIES NEUROSURGERY VOLUME 73 | NUMBER 4 | OCTOBER 2013 | 667 Copyright © Congress of Neurological Surgeons. Unauthorized reproduction of this article is prohibited.