Extended Window Thrombolytics for Ischemic Stroke: A Telestroke versus In-person Experience

Area of Science:

• Neurology
• Emergency Medicine
• Telehealth

Background:

• American Heart and Stroke Association Guidelines support telestroke for acute ischemic stroke.
• Limited data exists on the safety and outcomes of extended-window thrombolysis (>4.5 hours) via telestroke.
• This study addresses the gap by comparing telestroke to in-person care for extended-window thrombolysis.

Purpose of the Study:

• To evaluate the safety and outcomes of administering intravenous thrombolytic therapy for acute ischemic stroke using extended window criteria via telestroke compared to in-person care.
• To assess adverse events, specifically symptomatic intracranial hemorrhage (sICH).
• To compare functional outcomes and discharge disposition between telestroke and in-person treatment groups.

Main Methods:

• Retrospective cohort review of prospectively collected data from 2020-2022.
• Inclusion of patients from a multi-institutional health system with both in-person and telestroke services.
• Primary outcome: symptomatic intracranial hemorrhage (sICH); Secondary outcomes: favorable functional outcome (modified Rankin Scale 0-3) and discharge disposition.

Main Results:

• A total of 33 patients received extended-window thrombolysis (20 in-person, 13 telestroke).
• Symptomatic intracranial hemorrhage (sICH) occurred in one patient (4.8% in-person vs. 0% telestroke).
• No significant difference in favorable functional outcomes (mRS 0-3) or discharge disposition between telestroke and in-person groups.

Conclusions:

• Extended-window thrombolysis for acute ischemic stroke via telestroke is safe and effective.
• Telestroke care demonstrated no difference in adverse events compared to in-person treatment.
• These findings support the use of telestroke for extended window thrombolytic therapy in eligible stroke patients.