Evaluation of access to mechanical thrombectomy through teleconsultation in a regional stroke network

Introduction: Timely access to mechanical thrombectomy (MT) in acute ischemic stroke depends on rapid recognition of large vessel occlusion (LVO) and referral of eligible patients to an advanced center. This study examined how the multidisciplinary stroke teleconsultation system of the Bursa Regional Stroke Network contributes to the assessment of LVO and MT candidacy and to access to treatment.Methods: Consecutive stroke teleconsultations made to the Comprehensive Stroke Center of Bursa City Hospital between December 15, 2025 and June 14, 2026 were reviewed retrospectively. Clinical and imaging findings were evaluated by a multidisciplinary team. The presence of LVO, MT eligibility, consultation-to-decision time, and transfer and MT rates were recorded.Results: A total of 214 stroke teleconsultations were evaluated. The consultations came from Yalova (n=52), Gemlik (n=49), Çekirge (n=48), Balıkesir (n=43), Çanakkale (n=17), Bandırma (n=4), and Orhangazi (n=1). The median consultation-to-decision time was 8 minutes. LVO was identified in 118 patients (55.1%). Of these, 75 (63.6%) were found eligible for MT, whereas in 43 (36.4%) referral for MT was judged inappropriate after clinical and imaging assessment. Of the 41 patients consulted for LVO/MT after IVT, 25 (61.0%) were found eligible for MT, and 24 of them (96.0%) underwent MT. Of the 75 patients eligible for MT, 70 (93.3%) were transferred to our center. Transfer did not take place in five patients because of treatment refusal (n=2), clinical improvement (n=1), lack of bed capacity (n=1), and availability of interventional treatment at another center (n=1). MT was performed in 65 of the 70 transferred patients (92.9%). The procedure was not performed in five patients because there was no MT indication (n=2), the time window had been exceeded (n=1), vascular access could not be obtained (n=1), and the patient refused treatment (n=1) (Figure 1).Discussion/Conclusion: A teleconsultation-based regional stroke network allows rapid, clinical and imaging-based assessment of LVO and MT candidacy. The transfer of 93.3% of MT-eligible patients, and MT in 92.9% of those transferred, indicate that the system supports access of eligible patients to advanced treatment. By contributing to effective management of patient selection and transfer, this model may offer a feasible approach for regional stroke systems.Keywords: