An Internet-based examination system makes it possible for stroke patients in rural areas to be treated as rapidly as those in bigger hospitals with stroke teams, according to researchers at the Medical College of Georgia.

The Augusta, Georgia-based physicians have published their findings in the current issue of the journal Stroke.

A stroke occurs when a blood clot blocks a blood vessel, interrupting blood flow to the brain. Neurons in the immediate area of the stroke usually die within a few minutes to a few hours of the onset of the stroke.

Time is the critical issue for treating strokes. Only one clot-dissolving medicine, a Genentech drug called Activase and known to scientists as a tissue plasminogen activator (tPA), has been approved by the U.S. Food and Drug Administration. It must be given within three hours of the occurrence of symptoms.

“While we have a three-hour window, the evidence suggests that if you treat patients with tPA in under two hours or, even better, under 90 minutes, you improve your outcome,” said David Hess, chair of the Medical College of Georgia (MCG) Department of Neurology and lead author of the study.

Stroke Aid over the Web

The paper reports on a web-based tool called REACH (Remote Evaluation for Acute Ischemic Stroke), which was designed by MCG research scientist Sam Wang to provide a foundation for 24-hour acute stroke consultations with eight rural hospitals in Georgia.

The study tracked 30 patients who were treated with tPA following REACH-enabled consultations. Of these, seven patients received the drug within 90 minutes, and 18 (or 60 percent) were treated within two hours.

“There are some concerns that telemedicine would be too slow, there would be too many delays,” added Dr. Hess. “This shows you can treat quickly. If this works in a very difficult environment with small hospitals, it’s a model of what can be done in the state of Georgia or any state.”

Only a small percentage of stoke patients receive tPA both due to delays in patients finding medical assistance and the limited availability of stroke teams.