[Acute Stroke Care Systems:Pre-Hospital and In-Hospital Management]

Acute ischemic stroke care has evolved substantially since mechanical thrombectomy was established as an effective reperfusion therapy. As clinical outcomes are strongly dependent on the time to reperfusion, the optimization of pre-hospital and in-hospital stroke care systems has become increasingly important. In this review, the key components of an effective acute stroke care pathway are summarized, with a focus on pre-hospital triage using large-vessel occlusion scales, regional stroke networks, and institutional workflow optimization. Effective pre-hospital management includes standardized stroke assessment, rapid communication through dedicated stroke hotlines, and coordination among primary stroke centers, community hospitals, and telestroke networks. Key in-hospital strategies include early activation of multidisciplinary teams, streamlined imaging protocols, rapid decision-making for intravenous thrombolysis and mechanical thrombectomy, and standardized procedural workflows. Continuous case review and feedback involving stroke teams and emergency medical services further support quality improvement. The integration of efficient pre-hospital triage, coordinated multidisciplinary care, and standardized workflows is essential for minimizing treatment delays and improving outcomes in patients with acute ischemic stroke.