Abstract Body: Background: Telestroke allows rapid assessment of patients presenting with acute stroke symptoms for intravenous thrombolysis or endovascular thrombectomy (EVT). Although the safety and efficacy of telestroke services for the delivery of intravenous thrombolysis has been well established, evidence on EVT decision-making is scarce.
Methods: We analysed data from OPTIMISE, a quality improvement registry to support EVT implementation in Canada. We assessed for unadjusted differences in baseline characteristics, time metrics, and procedural outcomes between patients transferred for EVT who received telestroke consultation and those who didn’t receive the service. We used mixed-effects logistic regression models to compare the likelihood for symptomatic intracerebral hemorrhage (SICH), good functional outcome (defined as a modified Ranking Scale score of 0-2), or all-cause mortality at 90 days between the two groups. All models were adjusted for predefined confounders and participating centre.
Results: Patients receiving telestroke consultation (n=997; 15%) had higher rates of carotid terminus occlusion (23.9% vs. 14.3%), but similar rates of M1-MCA and basilar occlusion compared to patients not receiving telestroke consultation (n=5,561). Patients receiving telestroke consultation had longer onset-to-door time (300.5 vs. 175 minutes) and onset-to-groin puncture time (344 vs. 233 minutes), but shorter door-to-groin puncture time (40 vs.70 minutes) compared to those not receiving telestroke consultation. No differences in groin puncture to reperfusion times, successful reperfusion rates, or adverse periprocedural events were found between the two groups. In the unadjusted analyses patients receiving telestroke consultation had higher rate of SICH (6.5% vs 3.1%), a lower rate for good functional outcome at 90-days (35.6% vs. 40.6%) and higher rate for all-cause mortality at 90 days (39.9% vs. 27.5%) compared to those not receiving telestroke consultation. Those differences were eliminated in the adjusted analyses.
Conclusion: Patients receiving telestroke consultation prior to EVT have prolonged treatment times and worse outcomes, compared to patients that did not receive telestroke consultation prior to EVT. The higher risk for unfavorable outcomes was eliminated after adjustment for confounders, including treatment time. There is a need for quality improvement initiatives to optimize the workflow of patients receiving telestroke consultation prior to EVT.