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Updated: Aug 5, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Optimizing Acute Ischemic Stroke Systems of Care: Current State and Future Directions
Regina Royan1,2, Brian Stamm2,3, Shyam Prabhakaran4
1Department of Emergency Medicine (R.R.), University of Michigan, Ann Arbor.
Stroke
|July 30, 2026
Summary
Timely acute ischemic stroke reperfusion therapy access is limited by prehospital and interhospital care delays. Novel technologies aim to improve early stroke diagnosis and treatment decisions for better patient outcomes.
Area of Science:
- Neurology
- Emergency Medicine
- Health Systems Science
Background:
- Significant progress in stroke systems of care has not closed the gap in timely reperfusion therapy for acute ischemic stroke patients.
- Delays and variability in prehospital and interhospital care phases hinder access to critical stroke treatments.
Purpose of the Study:
- To review current evidence on acute stroke systems of care, focusing on prehospital identification, destination decision-making for large-vessel occlusion, and interhospital transfers.
- To examine system-level bottlenecks affecting access to and outcomes of reperfusion therapies.
- To describe emerging technologies that facilitate earlier stroke diagnosis and treatment.
Main Methods:
- Expert narrative review synthesizing current evidence.
- Analysis of key processes: prehospital response/scene times, destination decision-making, door-in-door-out metrics.
- Description of novel technologies: mobile stroke units, biomarkers, portable neuroimaging, telestroke.
Main Results:
- Persistent delays exist across prehospital dispatch, field assessment, destination selection, and interhospital transfer.
- System-level bottlenecks significantly impact timely access to reperfusion therapies.
- Emerging technologies show promise for earlier diagnosis and treatment initiation.
Conclusions:
- Optimizing prehospital and interhospital workflows is crucial for improving acute ischemic stroke reperfusion therapy delivery.
- Novel technologies can potentially shift accurate diagnosis and treatment decisions earlier in the stroke care pathway.
- Addressing system-level bottlenecks is essential to enhance patient outcomes in acute stroke care.
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