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Walter et al. Vessel Plus 2021;5:27 Vessel Plus
DOI: 10.20517/2574-1209.2020.102

Review Open Access

Stroke care equity in rural and remote areas - novel

strategies

1
3,4
2
1
1
Silke Walter , Klaus Fassbender , Damien Easton , Madeleine Schwarz , Fergus W. Gardiner , Francesca
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2
3,4
5
5
2
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Langenberg , Angela Dos Santos , Cees Bil , Kate Fox , Lara Bishop , Skye Coote , Henry Zhao , Sandy
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2,#
Middleton , Christopher Bladin , Stephen M. Davis , Geoffrey A. Donnan 2,#
1
Department of Neurology, Saarland University, Homburg 66421, Germany.
2
Melbourne Brain Centre, University of Melbourne, Melbourne 3050, Australia.
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The Royal Flying Doctor Service, Kingston ACT 2604, Australia.
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National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National
University, Canberra 0200, Australia.
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Department of Aerospace Engineering, RMIT University, Melbourne 3001 Australia.
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Australian Catholic University, Sydney 2001, Australia.
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Ambulance Victoria, and Monash University Melbourne 3800, Australia.
#
Authors contributed equally, joint senior authors.
Correspondence to: Prof. Geoffrey A. Donnan, Melbourne Brain Centre, Royal Melbourne Hospital, 4/300 Grattan St, Parkville
VIC 3050, Australia. E-mail: geoffrey.donnan@unimelb.edu.au
How to cite this article: Walter S, Fassbender K, Easton D, Schwarz M, Gardiner FW, Langenberg F, Santos AD, Bil C, Fox K,
Bishop L, Coote S, Zhao H, Middleton S, Bladin C, Davis SM, Donnan GA. Stroke care equity in rural and remote areas - novel
strategies. Vessel Plus 2021;5:27. https://dx.doi.org/10.20517/2574-1209.2020.102
Received: 24 Dec 2020 First Decision: 18 Jan 2021 Revised: 3 Feb 2021 Accepted: 8 Feb 2021 Published: 17 May 2021
Academic Editor: Aaron S. Dumont Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen
Abstract
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

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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