Telestroke (TS) training is not a formal requirement for the ACGME-accredited stroke fellowship. Simultaneously, managing acute ischemic (AIS) patients via TS is complex, in particular when transfer from a spoke to hub for endovascular therapy (EVT) is involved. The time from TS consult to groin puncture (page-to-puncture time, PTPT) may guide assessment of stroke fellow management of EVT via TS.

We identified patients in our TS registry from 9/2015 to 12/2018 who were evaluated remotely for AIS and transferred for EVT. Fisher exact test was use for categorical variables and Wilcoxon rank-sum test for continuous variables.

Among 4070 suspected AIS patients who were evaluated at one of 17 spokes via a TS consult, 123 were transferred for EVT, 7% of them were assessed by NVFs. There was no significant difference in baseline characteristics of patients seen by NVFs and NVAs, including age, sex, race/ethnicity, stroke severity, and baseline functional status. Among the patients seen by NVFs 11% had contraindication for tPA compared with 13% for NVA, P=1. tPA administration delays were seen in 25% of NVAs vs 50% of NVFs, P=0.2. Although tPA administration metrics at spokes were comparable between NVAs and NVFs, median PTPT was shorter in NVAs compared to NVFs by 42 minutes (212 (171,252) vs 254 (208,273) (median, Q1, Q3), P=0.06.

PTPT was shorter for NVAs although a larger cohort of NVFs is needed to better characterize this. Our findings support targeted integration of identification and transfer of EVT patients into TS training during stroke fellowship.