Comparable Benefit of Endovascular Therapy for Large Vessel Occlusion in Telestroke Patients

Introduction: A recent exploratory analysis suggested comparable outcomes among ischemic stroke patients undergoing endovascular therapy (EVT) for anterior circulation large vessel occlusion (acLVO), regardless whether selected via telestroke or admitted directly to an EVT-capable stroke center. The aim of this study was to determine the benefit of EVT in prospectively registered telestroke patients undergoing EVT for acLVO. Methods: We studied consecutive patients with acLVO who underwent EVT at our tertiary stroke center between January 2016 and March 2018. All transferred patients received repeated vascular imaging at our center. We compared clinical and imaging variables as well as safety and efficacy outcomes including symptomatic intracranial hemorrhage (sICH), major reperfusion (mTICI 2b/3), 90-days favorable functional outcome (mRS ≤2) and 90-days survival between patients transferred from telestroke hospitals and patients directly admitted to our stroke center. Results: Of 513 prospectively registered ischemic stroke patients screened for EVT eligibility during the 27-months study period, 164 had acLVO and eventually underwent EVT: median age 76 years (interquartile range, 66-82); 46% men; median NIHSS score 17 (13-20) points. Of these patients, 73 (44.5%) were transferred from a telestroke hospital and 91 (55.5%) were directly admitted to our tertiary stroke center. While telestroke patients had longer onset-to-needle (median: 128 [95-150] vs. 103 [87-122] min; p=0.051) and onset-to-groin puncture (median: 295.5 [248-340] vs. 180 [132-220] min; <0.0001) times than directly admitted patients, no further differences (p>0.05) in clinical and imaging variables were present between the two groups. The rates of sICH (2.7% vs. 1.1%; p=0.586), major reperfusion (80.8% vs. 76.9%; p=0.545), 90-days favorable functional outcome (23.9% vs. 28.9%; p=0.481) and 90-days survival (73.2% vs. 67.0%; p=0.393) were similar between telestroke and directly admitted patients. Conclusions: Our prospective data confirms that telestroke and directly admitted ischemic stroke patients have comparable outcomes following EVT for acLVO.