Background: Women and underserved populations remain less likely to receive thrombolysis for acute ischemic stroke and have been observed to have worse outcomes. While most Americans live within 60 minutes of a stroke-ready Emergency Department (ED), minority populations arrive later on average to the ED and are less likely to receive thrombolytics. Telestroke networks improve the quality of stroke care and increase use of acute treatments by bringing vascular neurologists to the bedside. In 2023, our multidisciplinary team established a regional telestroke network in underserved communities in Northeast Florida to expand access to expert stroke evaluation and treatment. The spoke network includes a Primary Stroke Center(PSC), a non-stroke certified hospital, and three freestanding emergency departments (FSEDs). Methods: Our group reviewed data from confirmed ischemic stroke patients evaluated via telestroke during the network’s first six months of operation (Project ID #2643). Patients who received tenectaplase(TNK) were compared to those who did not. Demographics, NIHSS, discharge and 90-day modified Rankin Score (MRS), length of stay, and adverse events were analyzed. Statistical analysis using Mann Whitney U testing with SPSS was performed. Results: Sixty ischemic stroke patients were evaluated via telestroke (TNK: n=19; no TNK: n=41). TNK-treated patients were more often female (68% vs. 34%) and had higher baseline stroke severity (median NIHSS 6 vs. 3) yet demonstrated shorter median hospital stays (2.0 vs. 3.5 days p=0.04). Functional independence (mRS 0–2) was achieved more frequently in the TNK group, both at discharge (81% vs. 50%) and at 90 days (93% vs. 65% p=0.04). Discharge home occurred in 88% of TNK-treated patients. There was one case of asymptomatic hemorrhagic conversion and one in-hospital death in the TNK group. Medicaid coverage was present in both TNK (5%) and non-TNK (12%) groups. Discussion: Implementation of a telestroke network serving a mix of FSEDs, a non-stroke certified hospital, and a PSC enabled timely delivery of thrombolytic therapy and was associated with favorable clinical outcomes. A notably high proportion of women received TNK, suggesting that telestroke may help close the longstanding gender gaps in acute stroke treatment. Our study was limited by low 90-day follow-up. These findings support the role of telestroke in promoting both effectiveness and equity in stroke care across varied healthcare settings.
Alwood et al. (2026) studied this question.