Abstract WP023: Virtual vs. Bedside: IVT for Minor Stroke via Telemedicine vs. In-Person Evaluation; Insights from the UTOPIA Study

Introduction: Minor acute ischemic stroke (AIS) is a heterogeneous condition, and evidence suggests IVT may be harmful in patients with non-disabling symptoms. The ARAMIS trial validated a standardized framework, aligned with TREAT Task Force criteria, to reduce variability in disability assessment. While telestroke(TS) is an established alternative for AIS triage, TS-guided IVT presents added challenges in disability determination. We evaluated the clinical characteristics, workflows, and safety of TS-guided IVT in mild AIS, stratified by TREAT criteria, within a large multi-hospital network. Methods: We retrospectively analyzed consecutive patients with presumed mild AIS (NIHSS ≤5) treated with IVT between January 2021 and December 2023 across suburban and urban hospitals. Patients were stratified by in-person vs TS evaluation and by fulfillment of TREAT Task Force disability criteria. Demographics, vascular risk factors, stroke etiology, workflow metrics (door-to-CT(dCT), door-to-needle (DTN)), and safety outcomes (symptomatic intracerebral hemorrhage(sICH), asymptomatic ICH(aICH)) were collected. Comparative analyses were performed across groups. Results: Of 480 patients treated with IVT, 374(78.1%) were evaluated via TS and 105(21.9%) in person. TS patients had lower rates of hyperlipidemia (39.2%vs57.1%,p