Bridging the Gap: Thrombolysis Access and Treatment Times Before and After Telestroke Implementation in Matão, Brazil

Intravenous thrombolysis (IVT) rates for acute ischemic stroke (AIS) remain suboptimal in Brazil, largely due to limited access to specialized stroke teams. Telestroke (TS) has emerged as a potential strategy to overcome geographic and structural barriers to timely stroke care, particularly in countries with continental dimensions such as Brazil. However, robust evidence regarding the effectiveness and safety of telestroke in the country remains scarce. The primary aim was to compare access to IVT before and after the implementation of a mobile TS program in the municipality of Matão, São Paulo. Secondary objectives included comparing treatment metrics, safety outcomes-specifically, intracranial hemorrhage and mortality-and functional independence at 90 days.

We conducted a retrospective analysis of a prospectively collected stroke registry, using an uncontrolled before-and-after (pre/post-implementation) design at Carlos Fernando Malzoni Hospital (Matão-SP), including patients with confirmed AIS between September 1, 2016, and August 31, 2022. Patients were divided into two groups: pre-TS (36 months before implementation) and post-TS (36 months after implementation). The TS platform used was the JOIN® app (Allm Inc., Tokyo, Japan).

Of 379 patients diagnosed with AIS during the 72-month period, the mean age was 69.8 ± 13.6 years, and 59.1% were male. The most common risk factors were hypertension (76.8%), diabetes mellitus (38.5%), and smoking (26.1%). Although 65.4% of patients arrived within 4.5 hours from symptom onset, only 58 (15.3%) received IVT. Nevertheless, the number and proportion of patients receiving IVT increased from 11 (6.7%) in the pre-TS period to 47 (22.0%) in the post-TS period (p < 0.001). Among thrombolysed patients, median door-to-needle time was significantly reduced from 145.0 minutes (IQR 119.0-265.0) pre-TS to 92.0 minutes (IQR 66.0-129.0) post-TS (p = 0.004). There were no significant differences in symptomatic intracranial hemorrhage (p = 1.000), 90-day mortality (p = 0.729), or 90-day functional outcomes (p = 0.742). In multivariable analysis, post-TS period (OR 5.65; 95% CI 2.68-11.93; p < 0.001) and higher NIHSS score at admission (OR 1.05; 95% CI 1.02-1.08; p = 0.002) were independently associated with IVT.

In this single-center before-and-after study, implementation of a mobile telestroke program was associated with higher rates of intravenous thrombolysis and shorter treatment times. No statistically significant differences were observed in symptomatic intracranial hemorrhage, 90-day mortality, or functional outcomes. These findings support further evaluation of mobile telestroke strategies in low- and middle-income settings.