Telestroke at UH Expands Access to Lifesaving Stroke Care

UH Clinical Update | September 2026

For decades, stroke treatment was often a race against a narrow window of opportunity. If patients arrived at the hospital too late, there was little physicians could do to prevent permanent brain injury and disability.

That reality has been changing.

At University Hospitals, advances in imaging technology, more effective interventions and the growing use of telestroke are helping specialists identify and treat more stroke patients than ever before, preserving brain function and improving outcomes once thought impossible.

Telestroke uses secure video technology to allow vascular neurologists to evaluate patients remotely. Through the program, stroke expertise is available regardless of where a patient presents within the UH system.

Planning for this major quality initiative began several years ago, driven by a regional and national shortage of stroke specialists and the growing recognition that advanced imaging would allow physicians to safely treat more patients beyond traditional time limits.

Over the past 18 months, telestroke has become a critical component of stroke care across UH. Using high-precision video technology developed at UH and advanced imaging, neurologists can determine within minutes whether symptoms represent a true stroke or a stroke mimic and recommend treatment accordingly.

Because stroke neurologists are also in short supply nationwide, telestroke allows specialists to extend their reach well beyond a single hospital. At UH, it also expands opportunities for specially trained residents working under supervision to participate in stroke evaluations.

"Stroke care has evolved dramatically in recent years," says Amrou Sarraj, MD, George M. Humphrey II Chair in Neurology, University Hospitals. "We're able to identify patients more accurately, determine who may benefit from treatment and get that treatment started much more quickly."

One of the biggest changes has been the shift away from relying solely on the clock. For years, clot-busting medications generally could be administered only within about 4.5 hours of symptom onset for ischemic stroke. Today, advanced imaging can identify viable brain tissue, allowing some patients to receive treatment up to 24 hours after symptoms begin.

Dr. Sarraj, who joined UH in 2021 as Director of the Comprehensive Stroke Center at UH Cleveland Medical Center and Director of Stroke Systems at the UH Neurological Institute, helped advance this approach through his research on thrombectomy, a procedure that removes a clot from the brain.

As global principal investigator of the landmark SELECT2 trial, he led research involving patients with large ischemic strokes who previously might not have qualified for intervention. The findings demonstrated that patients receiving thrombectomy along with medical therapy experienced significantly better outcomes, even when treated up to 24 hours after symptom onset. The results helped reshape international guidelines and expanded eligibility for treatments such as intravenous thrombolytics and thrombectomy.

Launching the telestroke program required a systemwide effort involving teams across UH hospitals. A task force led by Dr. Sarraj focused on logistics, data collection and workflow development, while the telehealth expertise of Brian D’Anza, MD, Telehealth Medical Director and project manager Molly Slota helped lay the foundation.

A pilot program launched at UH Ahuja Medical Center in May 2025.

"Its success gave us a foundation to expand across Northeast Ohio," says Dr. Sarraj. "Dr. Robert Hughes' leadership was vital in helping guide implementation across emergency departments." Dr. Hughes is the interim chair of Emergency Medicine.

Josh Petro, Unified Communications Architect, led UH's IT team in developing home-grown telestroke carts equipped with camera technology capable of supporting detailed neurologic examinations. Stroke coordinators and nurse leaders then helped train emergency department staff across the system on the technology and workflow.

In December 2025, UH also expanded telestroke services to five hospitals within the Aultman system. Providers are now available 24 hours a day, seven days a week, evaluating approximately 20 patients daily. The transfer referral center plays a vital role in the process by rapidly connecting the teams for every case and by coordinating timely transfers.

As the UH program grows, Dasul Jin, MD, Associate Director of the telestroke program, is helping lead ongoing quality initiatives.

This year, updated national guidelines expanded eligibility for clot-busting medications in select patients to as long as 24 hours after symptom onset when advanced imaging supports the treatment decision. UH has incorporated these recommendations into our clinical practice guidelines.

Because imaging now plays such a central role in stroke treatment decisions, UH has invested in advanced CT capabilities. CT perfusion imaging estimates the amount of brain tissue already lost and identifies potentially salvageable tissue. Artificial intelligence tools, including RapidAI, help analyze imaging studies across the system.

Telestroke also streamlines care in real time, says Kelly Montgomery, System Stroke Manager at UH. “Emergency physicians and neurologists can expedite thrombolytic decisions, prioritize immediate imaging and coordinate the next steps in treatment,” she says.

The interval between a patient's arrival and administration of clot-busting therapy, known as "door-to-needle" time, remains a critical measure of stroke care. Every minute saved can preserve brain tissue and improve the likelihood of recovery.

As Dr. Sarraj says, “Telestroke is about putting expertise where and when it is needed most."

By combining specialist expertise, advanced imaging and real-time communication, telestroke is expanding access to timely stroke care throughout Northeast Ohio, giving more patients the opportunity for meaningful recovery.