When someone is having a stroke, “time is brain.” Every minute that goes by means nearly 2 million neurons lost.
The window for medical intervention is short. Clot-busting drugs and surgical clot removal are most effective within a few hours of stroke onset.
If someone lives in an area where the local hospital doesn’t have stroke experts, their window for treatment could rapidly close — and their likelihood of death or long-term disability goes up.
Vascular neurologists from the Indiana University School of Medicine and IU Health are equalizing outcomes for patients across Indiana through “telestroke.” At a growing number of Indiana’s rural-area hospitals, this technology-assisted system of care brings a stroke expert remotely to the bedside within minutes of admitting a patient with stroke symptoms.
‘It probably saved my life.’
On July 24, Brady Powers, a research associate with the Indiana Institute on Disability and Community at IU Bloomington, was working remotely from his Martinsville home. He got up to let his dogs out, then suddenly felt dizzy. His right arm and leg went completely limp.
Having been trained in first aid, Powers immediately wondered if he was having a stroke. He called his parents, who live nearby, and they took him to IU Health Morgan Hospital, arriving within 15 minutes of his sudden right-side paralysis.
“It was dead weight,” Powers said of his limbs. “They were poking and prodding, but I couldn’t feel anything.”
Powers was quickly taken for a CT scan. As soon as he was wheeled back to his room, he was greeted by a specialist, Shaney Peña, MD, who had already begun chatting with his parents.
Only Dr. Peña wasn’t in the room. She was on a screen.
Peña is an Indianapolis-based stroke specialist with IU Health and an assistant professor of clinical neurology at the IU School of Medicine. She is the first graduate of the school’s Vascular Neurology Fellowship, which relaunched in 2024 after decades of closure. That same year, Fellowship Director Ann M. Jones, MD, also launched a telestroke pilot at three critical access hospitals in southern Indiana: IU Health Bedford, IU Health Paoli and IU Health Morgan in Martinsville.
“Being a resident here (at IU) and then doing the fellowship, I was able — thanks to the hard work that Dr. Jones has put in — to get training on telestroke,” Peña said. “It’s different to do things in that modality. Now I’m on faculty and participating in telestroke at night or during the day when I’m on service.”
That’s something Powers is abundantly grateful for.
“That connection to a professional right away was helpful in a moment of fear,” he said. “Dr. Peña was very calm and very realistic and shared with me in layman’s terms what was happening with my body.”
Peña explained that Powers was experiencing acute ischemic stroke and that the best treatment available is Tenecteplase, or TNK, a “clot-busting” drug that restores oxygen-rich blood flow to the brain. The quicker a patient is treated with TNK, the more likely they are to save brain function.
After hearing the drug’s risks and asking some questions, Powers gave informed consent. Then Peña walked the medical team at IU Health Morgan through proper dosing and administration of the drug via rapid IV push — all from the screen on the telestroke cart.
“Getting that information from Dr. Peña through telehealth is probably what saved my life and saved me from severe brain damage,” said Powers.
Three days after his stroke, he had regained full function in his right arm with returning function in his leg and only minor cognitive impairment. “My doctors are hopeful for a 100% recovery,” he said.
If Powers had experienced a stroke before the genesis of telemedicine, his odds might not have been so favorable.
“IU Health Morgan gives TNK, the clot busting medicine, infrequently — maybe three times a year — and because of that, there is a discomfort in using it because of its associated risk of causing bleeding,” explained Jones. “At our hub sites, being able to quickly access a stroke expert to examine the patient, regardless of location, allows for quick guidance on safe treatment, thereby reducing complications and improving outcomes.”
IU leads advanced stroke care in Indiana
During the pilot program’s first seven months, a team of 10 stroke specialists in Indianapolis and Bloomington conducted more than 75 telestroke visits. Their results were so convincing that the program is now being expanded to hospitals in northern Indiana.
“By the end of the year, it will be seven hospitals within IU Health — all over the state,” Jones said.
Before telestroke was implemented, just 2-3% of stroke patients at these rural hospitals were being treated with clot-busting drugs. Now that percentage is up to 8% — on par with IU Health Methodist Hospital, which is a certified Comprehensive Stroke Center, and other centers around the country, said Jones.
The hospitals in the pilot program also saw a significant reduction in time for transferring patients to Methodist Hospital when thrombectomy surgery was needed to mechanically remove clots. How quickly people went from admittance at their local hospital to discharge and transport fell from 400 minutes to 150 minutes.
“When every minute translates into 2 million neurons, the surgery isn’t helpful if there isn’t brain to save,” Jones said.
With grant funding from the IU School of Medicine-IU Health Neuroscience Institute, the vascular neurology team recently expanded telestroke coverage to IU Health Jay Hospital in Portland, Indiana, and will soon add three other northern Indiana hospitals: IU Health Tipton, IU Health Frankfort and IU Health White Memorial in Monticello.
Jones’ goal is to extend even further by partnering with hospitals outside of the IU Health system. “I’d like to add five sites in the next year and a half,” she said.
In the state of Indiana, there are only 14 certified vascular neurologists, and half are at IU, Jones noted.
“We are uniquely poised to be a leader in stroke care,” she said.
Telestroke connects patients to clinical research
Research discoveries over the past decade have dramatically advanced care options for people experiencing a stroke. Before the advent of clot-busting medicines like TNK and clot-removing surgical procedures, stroke was often what Jones called a “diagnose and adios” scenario: “We would identify it and tuck somebody into bed.”
Even with these medical advancements, the catch is they need to be done quickly: within 4.5 hours for TNK treatment and within 6 hours for thrombectomy. Much of the current research in the field now centers on pushing those boundaries. Clinical trials have shown that both surgical and drug treatments can be effective up to 24 hours for some patients.
At the IU School of Medicine, Kaustubh Limaye, MBBS, is leading a clinical trial exploring whether that window could be pushed even further, potentially allowing certain acute stroke patients to have a thrombectomy — a minimally invasive procedure that goes through an artery in the groin to physically remove a blood clot blocking a brain artery — up to 72 hours from the time the patient was “last known well.”
Another of Limaye’s clinical trials proved superior results for thrombectomies performed using a new “macrowire” device recently approved by the FDA.
Participating in these trials is a unique opportunity offered at IU. But without telestroke, patients at rural hospitals would likely never hear about it.
“When I talk with somebody (through telestroke) and I know that they qualify for one of the trials, I’ll bring that up,” Jones said. “It’s nice to be able to offer that.”
Although new technologies are advancing stroke care and extending treatment windows, everyone agrees it’s still best to get medical intervention as soon as possible after the onset of a stroke. Powers credits telestroke with his rapid TNK treatment — in less than an hour — preserving valuable brain cells.
“Without the interaction with telestroke and Dr. Peña and having the TNK push,” he said, “I wouldn’t be where I am right now.”
