Objective:

To assess the impact of vascular neurology subspecialty training on acute ischemic stroke (AIS) treatment and patient outcomes during telestroke consultations.

Background:

The rapid expansion of telestroke networks has been instrumental in improving access to timely AIS care. To meet this growing demand, many telestroke programs rely on both vascular and non-vascular neurologists. Comparative data evaluating differences in clinical decision-making and patient outcomes between these two provider groups remain limited.

Design/Methods:

We conducted a retrospective cohort study of telestroke consultations performed between March 2025 and July 2025 across 10 spoke centers within an academic telestroke network. Consultations were categorized by neurologist subspecialty based on fellowship training (vascular vs. non-vascular neurology). Collected variables included patient age, sex, baseline NIHSS, tenecteplase (TNK) administration rates, and incidence of post-TNK symptomatic intracranial hemorrhage (sICH). Categorical variables were analyzed using Chi-square or Fisher’s exact tests, and continuous variables using the Mann–Whitney U test.

Results:

A total of 2,019 telestroke consultations were analyzed, including 1,126 (56%) performed by vascular neurologists and 893 (44%) by non-vascular neurologists. TNK administration rates were similar between groups (8% vs. 7%, p = 0.63). Among patients who received TNK, there were no significant differences in age (p = 0.12), sex (p = 0.97), or median NIHSS (p = 0.86). The incidence of sICH (defined as NIHSS increase > 4) did not differ significantly between groups (2% vs. 1%, p = 1.00).

Conclusions:

Our findings demonstrated no statistically significant differences in patient characteristics, thrombolytic treatment rates, or post-treatment hemorrhage related outcomes between vascular and non-vascular neurologists conducting telestroke consultations. These results suggest that non-vascular neurologists can deliver comparable quality acute stroke care in telestroke networks. This supports the viability and safety of mixed provider telestroke coverage models to meet the growing demand for timely stroke care, particularly in resource limited or high-volume settings.