But there's another reason for Catto's reluctance to invest in telestroke technologies: They might not be worth it. "Right now the technology is such on a computer that you don't need a robot," she says. Particularly in the "stroke belt," a region in the Southeastern United States with particularly high stroke mortality rates, rural hospitals that can't afford advanced telestroke technology will find other methods. "People are just going to use computers."
Clinically, stroke care is venturing down a path already traveled by acute cardiovascular care. Treatments are becoming more interventional and a host of new devices promise to replace existing surgical procedures, says Bill Likosky, MD, medical director for stroke care at Swedish Medical Center in Seattle.
"We're following the pattern of heart disease, which says either break down a clot or reach in and make the artery bigger and take out the clot," he explains.
Tissue plasminogen activator, a clot-busting drug, has been the preferred first-response to stroke for several years, but the window for administering the medication is short and many patients don't receive it. Hospitals increasingly have alternatives, such as the Penumbra System that was approved by the FDA in late December 2007, which allows a clot to be suctioned out of the artery via catheter and has an eight-hour window for administering, compared to three hours for tPA.
Cedars-Sinai Medial Center was one of the first hospitals on the West Coast to install the Penumbra System and has since seen patients who were showing visible stroke signs, such as loss of speech, walk away after the procedure with virtually no sign that they had suffered a stroke, says Laurie Paletz, RN-BC, stroke program coordinator at the 952-bed hospital in Los Angeles.
That type of technology becomes a competitive advantage as hospitals begin airlifting patients to facilities that can perform the interventions. Going forward, devices like the Penumbra will likely distinguish the primary stroke centers from the advanced, comprehensive facilities, says Paletz.
"The trend for stroke seems to be procedural—device oriented in addition to medication," she says. "There are not a lot of new meds coming down the pike . . . but there certainly are new devices."