Use of Telestroke Prior to Endovascular Stroke Treatment in Canada: Results from the OPTIMISE Registry

BACKGROUND: Telestroke allows rapid assessment of acute stroke patients for intravenous thrombolysis and endovascular thrombectomy (EVT). While its safety and efficacy for thrombolysis are well established, evidence regarding EVT decision-making via telestroke is scarce. METHODS: We analysed data from Optimising Patient Treatment In Major Ischaemic Stroke with EVT (OPTIMISE), an EVT registry of Canadian comprehensive stroke centres. We compared unadjusted time metrics and procedural outcomes between patients treated with EVT evaluated via telestroke and those evaluated without telestroke. A primary analysis included all EVT cases, and a sub-analysis focused on patients transferred from another centre. Mixed-effects logistic regression, adjusted for relevant clinical and radiological confounders, was used to assess symptomatic intracerebral haemorrhage (sICH), good functional outcome and all-cause mortality. RESULTS: Between 2018 and 2021, a total of 6803 patients received EVT across 20 centres. Patients receiving telestroke consultation had longer onset-to-EVT centre door time and onset-to-groin puncture time. In unadjusted analyses, telestroke patients had higher sICH proportions (6.5% vs. 3.1%), lower proportions of good functional outcomes (35.6% vs. 40.6%) and higher all-cause mortality (39.9% vs. 27.5%) compared to those not receiving telestroke consultation. These differences did not persist in adjusted analyses. The sub-analysis with multivariate adjustment restricted to transferred patients also revealed no differences in outcomes between the two groups. CONCLUSION: Patients evaluated with telestroke prior to EVT had longer treatment times than those not evaluated with telestroke. The higher risk for unfavourable outcomes did not persist after adjustment for confounders. There remains a strong need to optimise the delivery of EVT for patients evaluated at telestroke centres.