2. The Reality of Telestroke:
Real People, Real Results
James M. Kiely, MD, PhD
CIO; AcuteCare Telemedicine
2014 Florida Telehealth Summit
“Connect to Quality”
3. “Hub & Spoke”
• Hub: Resources
• Spoke: Need
• Telestroke Provider:
• “The axle that turns the hub and spoke”
• Why? Stroke vs Neurologists
• Outcomes… not just about technology!
4. What is Stroke?
• Ischemic Stroke
• clot or plaque blocks blood flow
and starves brain cells of
oxygen
• 87% of strokes are ischemic
• Symptoms:
• sudden weakness, numbness,
blindness or loss of speech
• Think “F.A.S.T” – Time is Brain!
5. Stroke Facts in the U. S.
• 795,000 Americans suffer strokes each year
• 134,000 deaths each year
• 3rd leading cause of death
• 6,400,000 stroke survivors
• #1 cause of serious, long-term disability
Circulation 129:399-410, 2014
“Connect to Quality”
8. Where are the Neurologists?
• National crisis of availability; primarily rural
• Neurology 10:1212, April 2013
• Need minimum 2 for 24/7/365
• Lack of responsiveness
• Lack of comfort with tPA
9. A Brief History of Telestroke
• 1954 Harrison’s Textbook of Medicine:
• “There is no satisfactory medical treatment...”
• 1995 NEJM:
• Intravenous tPA effective within 3 hours
• 2009 AHA/ASA Endorse Telestroke
• Reduces barriers to acceptance
• 12 Regional Telehealth Resource Centers (TRC)
• Created to facilitate telemedicine in rural areas
10. Telestroke Results
• 30% improved at 3 months
• Time is Brain
• 1.9 million brain cells every minute
• tPA 3 Hour Window
• 4.5 hours select cases
• Door to Needle
• “Golden Hour”
11. Telestroke Benefits Beyond Thrombolysis
Cerebrovasc Dis 2009;27 (Suppl. 4):21-27
• Fewer unnecessary patient transfers
• Higher volume of care leads to better
outcomes
• Higher satisfaction of medical staff
• Stroke Mimics
• Thrombectomy
12. Real Results: Stroke Mimics
• J.B. 76 yo presenting with left hemiparesis
• ICH; no tPA, thrombectomy?
• Cortical signs: head and gaze deviation
• Remote presence: deviation to left, clonic movement,
Jacksonian March
• Wife recalls more history
• Admitted with Status Epilepticus
• D/C to Rehab after 1 week
13. Real Results: Thrombectomy
• D.S. 68yo “Wake Up Stroke”
• Aphasic, Hemiplegic
• Unknown time of onset
• Marcus Stroke Center: Perfusion Defect
• Puncture by 33 min, Retrieval by 29 min
• Recovery @ 2 Hrs
16. Real People, Real Results
Implementing a Successful Program
“Connect to Quality” 16
Successful Relationships
Require Strategic Goal
Alignment
Real People Working
Together for Real Results
17. The Reality of Telestroke:
Real People, Real Results
James M. Kiely, MD, PhD
CIO; AcuteCare Telemedicine
2014 Florida Telehealth Summit
“Connect to Quality”
