Related Experiment Video
Updated: Jan 17, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Code stroke of large vessel occlusion at triage improves candidate selection and workflow efficiency of endovascular
Po-Chia Cheng1, Pi-Shan Sung1, Yu-Ming Chang1
1Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Background:
Timely endovascular thrombectomy (EVT) for large vessel occlusion (LVO) is critical for optimal outcomes. We evaluated the impact of integrating LVO screening into Code Stroke activation ("Code LVO") at triage using the Los Angeles Motor Scale (LAMS) on EVT workflow efficiency.
Methods:
This single-center retrospective study included acute stroke patients presenting within 6 h of onset between January 2019 and February 2024. Patients were grouped into pre-Code LVO and Code LVO periods. Code LVO was triggered for LAMS ≥4, prompting direct computed tomography angiography (CTA) ± CT perfusion and early EVT team notification. Primary outcomes included imaging use, EVT rates, and key time metrics. Multivariate generalized linear models identified predictors of door-to-puncture time.
Results:
Among 1025 patients (808 pre-Code LVO, 217 Code LVO), Code LVO group was associated with more direct CTA (86.2 % vs. 30.9 %, P < 0.001), fewer duplicate non-contrast CT scans (8.8 % vs. 34.7 %, P < 0.001), and greater EVT rates (24.4 % vs. 11.0 %, P < 0.001). Median door-to-CTA (19 vs. 42 min) and door-to-puncture times (107.5 vs. 140 min) were significantly shorter (both P < 0.001). Intravenous thrombolysis times were unaffected (51.5 vs. 50 min, P = 0.424). In multivariate analysis, Code LVO independently predicted shorter door-to-puncture time (-22.6 min; P < 0.001).
Conclusions:
Implementing Code LVO at triage is feasible, reduces redundant imaging, expedites EVT workflow, and improves EVT candidate selection without delaying thrombolysis. This strategy may be particularly useful where universal CTA or direct-to-angiography approaches are impractical.
