Abstract WP023: Virtual vs. Bedside: IVT for Minor Stroke via Telemedicine vs. In-Person Evaluation; Insights from the UTOPIA Study

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Introduction: Minor acute ischemic stroke (AIS) is a heterogeneous condition, and evidence suggests IVT may be harmful in patients with non-disabling symptoms. The ARAMIS trial validated a standardized framework, aligned with TREAT Task Force criteria, to reduce variability in disability assessment. While telestroke(TS) is an established alternative for AIS triage, TS-guided IVT presents added challenges in disability determination. We evaluated the clinical characteristics, workflows, and safety of TS-guided IVT in mild AIS, stratified by TREAT criteria, within a large multi-hospital network. Methods: We retrospectively analyzed consecutive patients with presumed mild AIS (NIHSS ≤5) treated with IVT between January 2021 and December 2023 across suburban and urban hospitals. Patients were stratified by in-person vs TS evaluation and by fulfillment of TREAT Task Force disability criteria. Demographics, vascular risk factors, stroke etiology, workflow metrics (door-to-CT(dCT), door-to-needle (DTN)), and safety outcomes (symptomatic intracerebral hemorrhage(sICH), asymptomatic ICH(aICH)) were collected. Comparative analyses were performed across groups. Results: Of 480 patients treated with IVT, 374(78.1%) were evaluated via TS and 105(21.9%) in person. TS patients had lower rates of hyperlipidemia (39.2%vs57.1%,p<0.01) and higher rates of DMVO (21.0%vs9.6%,p<0.01). Ischemic stroke was more frequently the final diagnosis after in-person evaluation (68.6%vs47.5%,p<0.01). Workflow delays were observed in TS (median dCT 30vs16 min;DTN 70 vs49 min,both p<0.01). Safety outcomes were comparable, with sICH ≤2%.(Table 1) Overall, 216 patients (45.0%) fulfilled TREAT criteria; they were younger (median 64.3vs68.0 years,p=0.049) and had higher NIHSS (median 4vs2,p<0.01).(Table 2) Within the TREAT cohort (n=216), workflow delays persisted in TS evaluation (dCT 28vs12min;DTN 70vs47min,both p<0.01), though safety outcomes remained similar.(Table 3) Conclusion: TS-guided IVT in mild AIS is safe and feasible, with outcomes comparable to in-person evaluation despite longer workflow times. Patients meeting TREAT disability criteria were younger and more severely affected, supporting the utility of standardized frameworks to guide IVT decisions and reduce subjectivity in defining disability. These findings reinforce the role of telemedicine in extending access to thrombolysis while highlighting the need for workflow optimization and further study of functional outcomes.

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