Abstract 212: Intravenous Thrombolysis in Mild Ischemic Stroke by Disability Status: Experience from a Large Regional Telestroke Network

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Introduction/Purpose Minor acute ischemic stroke (AIS) is a heterogenous condition, and evidence suggests intravenous thrombolysis (IVT) poses risk to patients with non‐disabling symptoms. However, defining disability is variable and subjective. The ARAMIS trial validated a standardized framework, closely aligned with the TREAT Task Force criteria, which minimizes variability. While telestroke (TS) is a feasible alternative for triage and treatment of AIS, TS‐guided IVT decisions implicate variability in disability determination. Thus, we evaluated the clinical characteristics, workflow patterns, and safety of TS‐guided IVT in mild AIS stratified by disability status in our TS network spanning over 30 rural, suburban, and urban hospitals. Materials/Methods This is a retrospective analysis of a prospectively maintained database of patients evaluated within our large TS network. We identified patients with mild AIS (NIHSS≤5) symptoms who received IVT between January 2021 and December 2023. We report the clinical and demographic variables, stroke etiology, NIHSS, final diagnosis, workflow characteristics including door‐to‐needle time and door‐to‐CT time, and final disposition. Safety outcomes include mortality, symptomatic intracerebral hemorrhage (sICH), and asymptomatic intracerebral hemorrhage (aICH). Results Based on the TREAT definition of disability, 210 and 164 patients were included in the non‐disabling and disabling cohorts, respectively. The demographic and clinical characteristics were comparable between these groups (Table 1). Over 78% of patients were discharged home with no significant difference in disposition between disability status (p=0.103). When dichotomized into NIHSS of 0‐2 and 3‐5, we identified a significant difference between non‐disabling and disabling cohorts (p<0.01) as well as a difference in median NIHSS (median IQR 2 vs 4, p<0.001). No significant difference observed in mortality (3 vs 5, p=0.809), sICH (3% vs 3%), aICH (11% vs 7%, p=0.467) and IVT delivery metrics. Conclusion Comparing non‐disabling and disabling patients with presumed mild AIS receiving IVT in a large TS population (n=374), we found no significant difference in clinical characteristics, disposition, workflow metrics, or safety outcomes between these groups. However, significant differences existed in dichotomized NIHSS and median NIHSS between cohorts, highlighting application of the TREAT criteria. Our findings emphasize the subjectivity of disability assessment for IVT based on NIHSS alone and the utility of TREAT criteria in TS triage. Further research should explore the efficacy and functional outcomes in these cohorts of mild AIS. image

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