Abstract Body: Introduction: Telestroke (TS) plays an important role in extending Vascular Neurology (VN) expertise. Minor acute ischemic stroke (AIS), defined as presentation National Institute of Health Stroke Scale (NIHSS) 0-5 accounts for majority of AIS patients. Most studies evaluating Intravenous Thrombolysis (IVT) in this population were performed utilizing in-person assessments by VN experts, and data surrounding IVT for minor strokes utilizing TS platforms is lacking. Furthermore, determining the degree of disability among minor stroke patients may be particularly challenging when evaluating patients over TS platforms. We sought to describe our experience of TS-guided treatment of minor AIS patients with IVT within our large academic TS network.

Methods: This is a retrospective analysis of a prospectively maintained TS database spanning over 45 hospitals within our TS network staffed by academic VN service (VN fellows and fellowship-trained VN attendings) between January 2021 and April 2023. We included all consecutive patients who presented with NIHSS 0-5 and collected demographic variables, clinical/imaging characteristics, time-metrics and discharge outcomes. Video to IVT time (VTN) was defined as the time elapsed between beginning of the TS video evaluation to IVT administration. Symptomatic Intracranial hemorrhage (sICH) was defined according to the Heidelberg bleeding classification.

Results:192 patients were included in our analysis. Median age was 67.8 (58.3 – 76.6) years, median NIHSS was 3 (2-4), median VTN was 21.5 (17.0 – 29.0) min, and median LKWT – IVT administration time was 156.0 min (111.8 – 213.0). 47 (24.5%) patients had to be pre-treated for resistant hypertension. Large vessel occlusion (LVO) was detected in 25/190 (13.2%) patients, and an additional 9 (4.7%) patients had a distal medium vessel occlusion (DMVO). AIS was the final diagnosis in 92 (47.9%) patients. 6 (3.1%) patients had sICH. 140 (72.9%) patients were discharged home and 22 (11.5%) were discharged to rehabilitation facility. 6(3.2%) patients suffered in-hospital mortality.

Conclusion: Our experience of TS-guided IVT for minor stroke patients within a large, academic TS network demonstrated time-metrics and clinical outcomes comparable to those observed in previous RCTs evaluating IVT in this population assessed via in-person evaluations. Further research is needed to explore safety and efficacy of TS-guided IVT for minor stroke patients across other large TS systems.