Tpa for Patients Found to Have Stroke Mimics is Safe via Telemedicine

Introduction: tPA use is safe over telemedicine (TM) in acute ischemic stroke (AIS). Risk of tPA for stroke mimics (SM) is low when administered in-person. Assessment of SM over TM may differ than in-person given physical barriers. We evaluated differences between patients with a final diagnosis of SM versus AIS, who were treated with tPA via TM. Methods: We identified patients in our TM stroke registry (9/2015-12/2017) who received tPA for suspected AIS. We compared baseline patient characteristics and comorbidities, along with outcomes after tPA, between AIS and SM patients. Results: 693 patients received tPA via TM. Of these, 16.6% were found to have SM (13.2% were noted for in-person evaluations at our Comprehensive Stroke Center). SM patients were younger, less likely to have hypertension and atrial fibrillation, but more likely to have self-reported history of stroke, TIA, or seizure (Table 1). SM patients presented with milder stroke and less likely with face droop (Table 1). Adverse events from tPA in SM patients were minimal, with no observed symptomatic hemorrhages. mRS, discharge disposition, and length of stay were better for SM than AIS patients (Table 2). Door-to-needle time was six minutes longer for SM than AIS patients via TM (Table 2). Conclusion: In circumstances over TM where the diagnosis of AIS is unclear, tPA may take longer to consider but is safe to administer. Certain comorbidities and presenting symptoms may help differentiate SM from AIS via TM.