Telemedicine and stroke: Telestroke. ``The role of telemedicine in stroke''

The telemedical aspects of stroke patient management are referred to as ``telestroke'' and have been an integral part of the organization of stroke management systems since the implementation of the French National Stroke Plan 2010-2014. Telestroke allows for equity of care at all stages of the disease by facilitating access to stroke unit (SU). Because telestroke allows information skills and responsibilities to be shared between practitioners during all procedures (teleconsultation, teleexpertise, teleassistance and remote monitoring). The implementation of telemedical tools requires precise specifications and defined procedures in which the role of each participant is predetermined (emergency physicians, radiologists, neurologists, etc.). Telestroke models can be adapted according to the needs of each region and the resources available (imaging platforms, emergency room, SU, interventional neuroradiology, etc.). It is common practice to separate the acute phase studies, carried out pre-hospital or in hospital (from the call to the emergency services, to the sending of ambulances equipped with video technology or even an on-board scanner), from studies carried out in the chronic phase. Likewise, treatment may be fragmented (access to thrombolysis only), or completely integrated, organizing the entire stroke treatment pathway. The majority of telestroke studies concerns acute management. There have been few socioeconomic studies to determine the true impact of telestroke in medical and economic terms. Telemedicine applied to stroke not only contributes to the substitution effect due to limited resources, but more importantly to the dissemination of knowledge and skills for optimal management of the right patient, at the right time, in the right place and with appropriate treatment. Telestroke is a response to the scarcity of medical resources, an aid in the face of the technical nature of stroke patient management, and thus contributes to equal access to care and the overall efficiency of the healthcare system. (C) 2020 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.