6th Edition of Neurology World Conference 2026

Abstract

Background Recurrent ischemic stroke carries increased morbidity and mortality, yet patients with a prior stroke may be less likely to receive intravenous thrombolysis. Telestroke expands access to stroke specialists and rapidly decreases time to treatment, but its impact on rtPA decision making in patients with previous stroke is not well defined. This study examined clinical factors associated with rtPA inclusion or exclusion among acute ischemic stroke patients with a documented history of prior stroke, comparing telestroke and non-telestroke evaluations. Methods This retrospective study analyzed 1,947 patients with a history of prior stroke who presented with acute ischemic stroke within 24 hours of symptom onset between 2010 and 2016. Bivariate analyses assessed demographic and clinical differences between rtPA-treated and untreated patients, stratified by telestroke and non-telestroke evaluation. Multivariate logistic regression with backward selection identified independent predictors of rtPA administration or exclusion. Model calibration and discrimination were assessed using the Hosmer-Lemeshow test and area under the receiver operating characteristic curve (AUC), respectively. Results Among 1,947 patients, 318 (16.3%) received rtPA. In the overall cohort, rtPA-treated patients had higher rates of depression, migraines, obesity, smoking, and antidepressant use, as well as higher NIHSS scores. They were younger and had lower rates of atrial fibrillation, coronary artery disease, diabetes, and carotid stenosis. Laboratory values including blood glucose, creatinine, INR, heart rate, and systolic blood pressure were also lower. In the telestroke subgroup, rtPA recipients more frequently had depression, migraines, obesity, smoking, and antidepressant use, and were less likely to have atrial fibrillation, carotid stenosis, or diabetes. Logistic regression identified atrial fibrillation, carotid stenosis, and diabetes as predictors of exclusion, while obesity and smoking predicted inclusion (AUC = 0.629). In the non-telestroke subgroup, antidepressants use predicted exclusion (AUC = 0.571). Conclusion In patients with a history of previous stroke, clinical patterns associated with rtPA treatment differ between telestroke and non-telestroke settings. Telestroke evaluations incorporated a broader range of clinical factors, excluding patients with high vascular comorbidity while maintaining access for eligible patients, whereas non-telestroke evaluations showed fewer distinguishing predictors. These findings suggest that telestroke may support more comprehensive decision-making regarding rtPA eligibility in patients with prior stroke. Further research is warranted to assess whether these differences influence functional outcomes and to optimize thrombolysis pathways in complex stroke populations.