Stroke care equity in rural and remote areas - novel strategies

Acute stroke is one of the most common causes of disability worldwide and numbers are projected to increase. Modern and successful recanalizing treatments are available, but timely access to these treatments is most often restricted to urban populations. This disparity affects nearly half of the world’s population, particularly those living in rural and remote areas, and most often affects people with indigenous background. We provide information on this disparity in acute stroke care between rural, remote, and urban areas. We discuss potential new management strategies which could facilitate the timely delivery of acute stroke care to those residents beyond the better serviced urban areas. We focus on the concept of a mobile stroke unit (MSU), especially an Air-MSU. This aircraft solution could provide an imaging capability and immediate clinical expertise via linked telemedicine to diagnose and treat acute stroke patients at the emergency site. The Air-MSU is not only envisioned to allow intravenous thrombolysis in the field but also to allow pre-hospital triage to comprehensive stroke centres through use of contrast imaging to diagnose large vessel occlusion, facilitating endovascular thrombectomy. Moreover, issues regarding optimal operating environment as well as novel imaging and diagnostic devices, which could facilitate the implementation of an Air-MSU are discussed. Innovative health care solutions are urgently needed to close the treatment gap for stroke patients living in rural and remote regions worldwide.