Background: Intravenous thrombolysis in acute ischemic stroke patients (AIS) via telestroke (TS) is safe and effective, with comparable functional outcomes to patients treated at academic stroke centers. However, the association between demographic, clinical and TS logistic factors and functional outcome at 3 months in TS patients has not been studied. Identification of TS specific predictors of good outcome may guide future strategies of care delivery.
Aim: To determine demographic, clinical, and TS logistic variables associated with 90-day functional outcome in AIS patients treated with IV tPA via TS.
Methods: We retrospectively analyzed all TS consults treated with IV tPA between January 2016-July 2017 in our state-wide telestroke network. Patients who underwent endovascular intervention were excluded. Fisher exact and χ2 test for categorical and Student t test for continuous variables with a significance level of <0.05 were used. Stepwise logistic regression model was used to identify predictors for favorable outcome (mRS 0-2) at 3 months
Results: tPA was given to 400 AIS patients via TS. Functional outcome at 90 days was obtained in 94.3% patients. Mean age was 66.8 years and 62% patients were Caucasian. Median NIHSS on presentation was 7. Medical history included hypertension (72%), diabetes (36%), hyperlipidemia (25%), atrial fibrillation (AF) (11%), and CHF (5%). Mean “onset to needle” time was 138.4 minutes(min) and mean “door to needle time” was 61.4 min. Mean “door to login” time was 26.2 min, and mean “login to tPA” time was 19.7 min. Symptomatic ICH and asymptomatic ICH occurred in 15 (5.98%) and 28(11.3%) respectively. Younger age, lower NIHSS at presentation, lower door to login time, and absence of AF and CHF were associated with higher odds of good functional outcome at 90 days in univariate analyses. In multivariate logistic regression, age (OR 0.75, 95% CI 0.67-0.84) and NIHSS at presentation (OR 0.85, 95% CI 0.82-0.89) remained independent predictors.
Discussion: Younger patients and patients with low NIHSS at presentation are more likely to have good outcome post IV tPA treatment via TS. Larger studies powered to measure the impact of TS delivery variables on functional outcome are needed.