ABSTRACT NUMBER: ESOC2026A1581 TELESTROKE TRIAGE IMPROVES WORKFLOW EFFICIENCY IN PATIENTS UNDERGOING ENDOVASCULAR TREATMENT FOR LARGE VESSEL OCCLUSION: A SINGLE-CENTER COHORT STUDY

Abstract Background and aims Timely treatment is crucial to improve stroke outcomes, yet prehospital and in-hospital delays remain significant challenges. Telestroke prehospital triage using real-time video communication between emergency medical services (EMS) personnel and hospital-based stroke physicians may expedite stroke care workflows. We assessed whether telestroke implementation reduces workflow times in patients undergoing endovascular treatment (EVT). Methods Prospective single-center cohort study in Basel, Switzerland. Individuals with suspected large vessel occlusion (LVO) were assessed via a live video link between EMS and a neurologist using the RACE-Score, a 5-item scale evaluating facial palsy, arm and leg motor function, head and gaze deviation, aphasia or agnosia. Patients were managed according to an established prenotification protocol that alerted all teams involved and allowed preparation of the angio suite before arrival. Telestroke cases were compared with propensity score-matched controls from the Swiss Stroke Registry. Results 132 patients undergoing thrombectomy were included (44 telestroke, median age 81.5 years, 21% female; 88 matched controls). Nineteen patients (10.9%) received bridging thrombolysis. Median door-to-puncture-time was significantly shorter in the telestroke group than in controls (65.5 [51.8-82.8] vs 85 [73.2-102.5] minutes; p = 0.001), while door-to-needle times were comparable (35 [30.0-43.5] vs 37 [51.8-82.8] minutes). No increase in onset-to-arrival time was observed. Conclusions Telestroke triage appears to reduce door-to-puncture times in LVO patients undergoing EVT without extending prehospital delays. These findings suggest telestroke could improve stroke workflow efficiency and expedite access to EVT, though further research is needed to assess its impact on clinical outcome and healthcare resources. Conflict of interest Sebastian Thilemann: nothing to disclose.