‘Drip-and-drive’: shipping the neurointerventionalist to provide mechanical thrombectomy in primary stroke centers

2018 ◽  
Vol 10 (10) ◽  
pp. 932-936 ◽  
Author(s):  
Caspar Brekenfeld ◽  
Einar Goebell ◽  
Holger Schmidt ◽  
Henning Henningsen ◽  
Christoffer Kraemer ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Primary Outcome Measure ◽  
Telephone Call ◽  
Time Intervals ◽  
Stroke Treatment ◽  
Care Models ◽  
Increasing Demand ◽  
Comprehensive Stroke Center ◽  
Stroke Center

BackgroundTo satisfy the increasing demand of mechanical thrombectomy (MT) for acute ischemic stroke treatment, new organizational concepts for patient care are required. This study evaluates time intervals of acute stroke management in two stroke care models, including one based on transportation of the interventionalist from a comprehensive stroke center (CSC) to treat patients in two primary stroke centers (PSC). We hypothesized that time intervals were not inferior for the ‘drip-and-drive’ concept compared with the traditional ‘drip-and-ship’ concept.MethodsPatients treated with MT at the PSC (‘drip-and-drive’, ‘D+D group’) were compared with patients transferred from PSC to CSC for MT (‘drip-and-ship’, ‘D+S group’) with regard to time delays. Time intervals assessed were: symptom onset to initial CT, to angiography, and to recanalization; time from initial CT to telephone call activation, to arrival, and to angiography; and time from telephone call activation to arrival and from arrival to angiography.Results42 patients were treated at the PSC after transfer of the interventionalist, and 32 patients were transferred to the CSC for MT. The groups did not differ with regard to median Onset–CT and CT–Phone times. Significant differences between the groups were found for the primary outcome measure CT–Arrival time (‘D+D group’: median 121 (IQR 108–134) min vs 181 (157–219) min for the ‘D+S group’; P<0.001). Time difference between the groups increased to more than 2 hours for median CT–Angio times (median 123 (IQR 93–147) min vs 252 (228–275) min; P<0.001).ConclusionTime intervals for the ‘D+D group’ were not inferior to those of the ‘D+S group’. Moreover, under certain conditions, the ‘drip-and-drive’ concept might even be superior.

Abstract TP289: Code Neuro-Intervention a New Necessity: Reality of Shifting Stroke Care Paradigm

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Laura Suhan ◽  
Spozhmy Panezai ◽  
Jaskiran Brar ◽  
Audrey Z Arango ◽  
Anna Pullicino ◽  
...  
Keyword(s):  
Stroke Care ◽  
Work Hours ◽  
Stroke Treatment ◽  
Angiography Suite ◽  
Stroke Team ◽  
Cross Training ◽  
Code Process ◽  
Time Parameters ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Various strategies have been implemented to reduce acute stroke treatment times. A unique code process pathway was designed at our hospital specifically to be activated by the stroke team for the purpose of rapidly assembling the Neurointerventional team. Methods: Code Neurointervention (NI), was designed and tested from January 2014 to April 2014 for all the patients who presented with ischemic strokes to our community based, university affiliated comprehensive stroke center. We retrospectively analyzed all patients who had Code NI called from May 1, 2014 to April 30, 2015 and compared them to patients who underwent acute endovascular treatment the prior year (Non Code NI). The following parameters were compared: decision to recanalization and door to recanalization times. Further analysis was done to compare patients presenting during business hours (Monday-Friday 8am-5pm) and off hours using GraphPad QuickCalcs Web site. Results: There were 28 Code NI; 14 were called during work hours and 14 during off hours. The previous year 25 patients underwent acute endovascular intervention; 12 during work hours and 13 during off hours. Mean decision to recanalization time was 106 (Code NI) vs 115 minutes (Non Code NI) (p<0.0.6) during work hours and 154 (Code NI) vs 139 minutes (Non Code NI) (p<0.37) during off hours. Mean door to recanalization time was 169 (Code NI) vs 173 minutes (Non Code NI) (p<0.85) during work hours and 252 (Code NI) vs 243minutes (Non Code NI) (p< 0.75) during off hours. Subset analysis of time parameters for patients in Code NI group showed mean decision to recanalization times of 106 minutes during work hours vs 154 minutes off work hours (p<0.004). Mean door to recanalization times were 169 minutes vs 251 minutes (p<0.0003), respectively. Conclusion: Institution of Code NI significantly improved intervention time parameters during work hours as compared to off hours. Rapid assembly of the neurointervention team, rapid availability of imaging and angiography suite likely contribute to these differences. Further initiatives, such as improving neurointervention staff availability during off hours or cross training other staff can further improve acute intervention time parameters.

scholarly journals Mandatory Neuroendovascular Evolution: Meeting the New Demands

2018 ◽  
Vol 8 (1) ◽  
pp. 69-82
Author(s):  
Mohammad El-Ghanem ◽  
Francisco E. Gomez ◽  
Prateeka Koul ◽  
Rolla Nuoman ◽  
Justin G. Santarelli ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Mechanical Thrombectomy ◽  
Stroke Care ◽  
Endovascular Intervention ◽  
Stroke Patients ◽  
Hub And Spoke ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Traditionally, patients undergoing acute ischemic strokes were candidates for mechanical thrombectomy if they were within the 6-h window from onset of symptoms. This timeframe would exclude many patient populations, such as wake-up strokes. However, the most recent clinical trials, DAWN and DEFUSE3, have expanded the window of endovascular treatment for acute ischemic stroke patients to within 24 h from symptom onset. This expanded window increases the number of potential candidates for endovascular intervention for emergent large vessel occlusions and raises the question of how to efficiently screen and triage this increase of patients. Summary: Abbreviated pre-hospital stroke scales can be used to guide EMS personnel in quickly deciding if a patient is undergoing a stroke. Telestroke networks connect remote hospitals to stroke specialists to improve the transportation time of the patient to a comprehensive stroke center for the appropriate level of care. Mobile stroke units, mobile interventional units, and helistroke reverse the traditional hub-and-spoke model by bringing imaging, tPA, and expertise to the patient. Smartphone applications and social media aid in educating patients and the public regarding acute and long-term stroke care. Key Messages: The DAWN and DEFUSE3 trials have expanded the treatment window for certain acute ischemic stroke patients with mechanical thrombectomy and subsequently have increased the number of potential candidates for endovascular intervention. This expansion brings patient screening and triaging to greater importance, as reducing the time from symptom onset to decision-to-treat and groin puncture can better stroke patient outcomes. Several strategies have been employed to address this issue by reducing the time of symptom onset to decision-to-treat time.

Abstract MP24: Pitfalls of Mobile Stroke Treatment Unit - A Single Center Review

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mangala Gopal ◽  
Ciaran Powers ◽  
Shahid M Nimjee ◽  
Sharon Heaton ◽  
Vivien Lee
Keyword(s):  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Acute Stroke Care ◽  
Treatment Unit ◽  
Stroke Treatment ◽  
The Mean ◽  
Suspected Stroke ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: Although Mobile Stroke Treatment Units (MSTU) can reduce time to intravenous thrombolysis (IVtPA), limitations in MSTU care have not been well described. Methods: We retrospectively reviewed consecutive patients transported by MSTU to our academic comprehensive stroke center (CSC) from May 2019 to August 2020 for suspected stroke to assess for potential limitations of care. The Columbus MSTU is owned by a separate health system, but represents a collaborative venture with 3 CSCs and the Columbus Division of Fire, operating daily from 7am-7pm. Data was abstracted on demographics, clinical presentation, last known normal (LKN) time, initial National Institutes of Health Stroke Scale (NIHSS), neuroimaging, and IVtPA administration. Results: Among 93 patients transported to our CSC by MSTU, the mean age was 65 years (range, 21-93) and 61 (66%) were female. The mean initial NIHSS was 7.1 (range, 0 to 33) and 52 (55.9%) had a final diagnosis of stroke (4 hemorrhagic, 48 ischemic). IVtPA was administered in 15 (16.1%) with a mean LKN to IVtPA time of 120 minutes (range, 41 to 243). Among 15 patients treated with IVtPA, 10 received IVtPA in MSTU and 5 in CSC ED. In 7 patients who underwent thrombectomy, mean door to groin time was 57 minutes (range, 28 to 88). Among the overall group, 9 (9.7%) cases were identified with limitations in MSTU care, including 2 patients who received IVtPA by MSTU that were more than 10% off from ideal dosing (underdosed by 9mg and overdosed by 21mg), 1 warfarin-associated hemorrhage requiring intubation who did not receive reversal in MSTU but did upon arrival to CSC ED, and 5 patients who received IVtPA after arrival to CSC ED. The reasons for withholding IVtPA included inability to confirm LKN, patient declination, lack of translator, incorrect LKN, and seizure requiring intubation. The LKN to IVtPA time was significantly longer in the ED compared to MSTU (197 vs 82 minutes, p <0.0001). Conclusion: In our series of suspected stroke patients evaluated by MSTU, gaps identified within MSTU acute stroke care were related to limitations of resources and included errors in weight-based IVtPA dosing, inability to administer IVtPA, or reversal for anti-coagulation related hemorrhage. Clinicians need to be aware of potential pitfalls of MSTU evaluation.

Abstract WMP20: Effect of Leukoaraiosis on Outcomes of Mechanical Thrombectomy and Proposed New Leukoaraiosis-Aspects Score

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Waleed Brinjikji ◽  
John Benson ◽  
Alejandro A Rabinstein ◽  
David F Kallmes
Keyword(s):  
Mechanical Thrombectomy ◽  
Primary Outcome Measure ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Endovascular Recanalization ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Fazekas Scale

Background and Purpose: Leukoaraiosis is a poor prognostic marker for patients with acute ischemic stroke (AIS). This study sought to assess if severity of leukoaraiosis is associated with outcome in patients with AIS following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score to improve its predictive value for good outcome. Methods: We analyzed consecutive patients with AIS that underwent mechanical thrombectomy for anterior circulation large vessel occlusion at our comprehensive stroke center. Leukoaraiosis burden was graded using the Fazekas scale (combined scores from two locations categorically divided into no leukoaraiosis (score = 0), mild (1-2), moderate (3-4) and severe (5-6)). The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS (“L-ASPECTS”) was calculated by subtracting values from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe). Results: Of 174 included patients, 89 (51.2%) were female; average age was 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (p=0.0005) as well as those that were successfully revascularized (p=0.0002). A multivariate analysis confirmed that leukoaraiosis burden was associated with worse 90-day mRS among all patients (mild: p=0.006; moderate: p=0.002; severe: p=0.03), as well as those that underwent successful thrombectomies (p=0.005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the association was stronger with L-ASPECTS (p<0.0001 and AUC=0.7 for L-ASPECTS; p=0.04 and AUC=0.59 for ASPECTS). Conclusion: Leukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.

scholarly journals Coronavirus disease 2019 is threatening stroke care systems: a real-world study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jiawei Xin ◽  
Xuanyu Huang ◽  
Changyun Liu ◽  
Yun Huang
Keyword(s):  
Real World ◽  
Mainland China ◽  
Stroke Care ◽  
Hospital Length ◽  
Real World Data ◽  
Care Systems ◽  
Long Term Prognosis ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Medical Burden

Abstract Background Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the stroke care systems have been seriously affected because of social restrictions and other reasons. As the pandemic continues to spread globally, it is of great significance to understand how COVID-19 affects the stroke care systems in mainland China. Methods We retrospectively studied the real-world data of one comprehensive stroke center in mainland China from January to February 2020 and compared it with the data collected during the same period in 2019. We analyzed DTN time, onset-to-door time, severity, effects after treatment, the hospital length of stays, costs of hospitalization, etc., and the correlation between medical burden and prognosis of acute ischemic stroke (AIS) patients. Results The COVID-19 pandemic was most severe in mainland China in January and February 2020. During the pandemic, there were no differences in pre-hospital or in-hospital workflow metrics (all p>0.05), while the degree of neurological deficit on admission and at discharge, the effects after treatment, and the long-term prognosis were all worse (all p<0.05). The severity and prognosis of AIS patients were positively correlated with the hospital length of stays and total costs of hospitalization (all p<0.05). Conclusions COVID-19 pandemic is threatening the stroke care systems. Measures must be taken to minimize the collateral damage caused by COVID-19.

Impact of RapidAI mobile application on treatment times in patients with large vessel occlusion

2021 ◽  
pp. neurintsurg-2021-017365
Author(s):  
Mais Al-Kawaz ◽  
Christopher Primiani ◽  
Victor Urrutia ◽  
Ferdinand Hui
Keyword(s):  
Mobile Application ◽  
Secondary Analysis ◽  
Multiple Linear Regression Model ◽  
Stroke Care ◽  
Mobile App ◽  
Large Vessel ◽  
Vessel Occlusion ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Adjusted Model

BackgroundCurrent efforts to reduce door to groin puncture time (DGPT) aim to optimize clinical outcomes in stroke patients with large vessel occlusions (LVOs). The RapidAI mobile application (Rapid Mobile App) provides quick access to perfusion and vessel imaging in patients with LVOs. We hypothesize that utilization of RapidAI mobile application can significantly reduce treatment times in stroke care by accelerating the process of mobilizing stroke clinicians and interventionalists.MethodsWe analyzed patients presenting with LVOs between June 2019 and October 2020. Thirty-one patients were treated between June 2019 and March 2020 (pre-app group). Thirty-three patients presented between March 2020 and October 2020 (post-app group). Mann–Whitney U test and Kruskal–Wallis tests were used to examine variables that are not normally distributed. In a secondary analysis we analyzed interhospital time metrics between primary stroke centers and our comprehensive stroke center.ResultsBaseline demographic and vascular risk factors were similar in both groups. Use of Rapid Mobile App resulted in 33 min reduction in DGPT (P=0.02), 35 min reduction in door to first pass time (P=0.02), and 37 min reduction in door to recanalization time (P=0.02) in univariate analyses when compared with patients treated pre-app. In a multiple linear regression model, utilization of Rapid Mobile App significantly predicted shorter DGPT (P=0.002). In an adjusted model, National Institutes of Health Stroke Scale (NIHSS) 24 hours after procedure and at discharge were significantly lower in the post-app group (P=0.03). Time of transfer between primary and comprehensive stroke center was comparable in both groups (P=0.26).ConclusionIn patients with LVOs, the implementation of the RapidAI mobile application was independently associated with reductions in intrahospital treatment times.

Detection of Large Vessel Occlusion Stroke in the Prehospital Setting

Stroke ◽  
2021 ◽  
Author(s):  
Laura C.C. van Meenen ◽  
Maritta N. van Stigt ◽  
Arjen Siegers ◽  
Martin D. Smeekes ◽  
Joffry A.F. van Grondelle ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Stroke Care ◽  
Prehospital Setting ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
User Friendliness ◽  
Vessel Occlusion ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Good Diagnostic Accuracy

A reliable and fast instrument for prehospital detection of large vessel occlusion (LVO) stroke would be a game-changer in stroke care, because it would enable direct transportation of LVO stroke patients to the nearest comprehensive stroke center for endovascular treatment. This strategy would substantially improve treatment times and thus clinical outcomes of patients. Here, we outline our view on the requirements of an effective prehospital LVO detection method, namely: high diagnostic accuracy; fast application and interpretation; user-friendliness; compactness; and low costs. We argue that existing methods for prehospital LVO detection, including clinical scales, mobile stroke units and transcranial Doppler, do not fulfill all criteria, hindering broad implementation of these methods. Instead, electroencephalography may be suitable for prehospital LVO detection since in-hospital studies have shown that quantification of hypoxia-induced changes in the electroencephalography signal have good diagnostic accuracy for LVO stroke. Although performing electroencephalography measurements in the prehospital setting comes with challenges, solutions for fast and simple application of this method are available. Currently, the feasibility and diagnostic accuracy of electroencephalography in the prehospital setting are being investigated in clinical trials.

scholarly journals Impact of COVID-19 Pandemic on the Incidence, Prehospital Evaluation, and Presentation of Ischemic Stroke at a Nonurban Comprehensive Stroke Center

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Cesar Velasco ◽  
Brandon Wattai ◽  
Scott Buchle ◽  
Alicia Richardson ◽  
Varun Padmanaban ◽  
...  
Keyword(s):  
Urban Areas ◽  
Stroke Care ◽  
Final Diagnosis ◽  
Medical Attention ◽  
Presenting Symptoms ◽  
Number Of Patients ◽  
Community Transmission ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
The Impact

Introduction. Many reports have described a decrease in the numbers of patients seeking medical attention for typical emergencies during the COVID-19 pandemic. These reports primarily relate to urban areas with widespread community transmission. The impact of COVID-19 on nonurban areas with minimal community transmission is less well understood. Methods. Using a prospectively maintained prehospital quality improvement database, we reviewed our hospital EMS transports with a diagnosis of stroke from January to April 2019 (baseline) and January to April 2020 (pandemic). We compared the volume of patients, transport/presentation times, severity of presenting symptoms, and final diagnosis. Results. In January, February, March, and April 2019, 10, 11, 17, and 19 patients, respectively, were transported in comparison to 19, 14, 10, and 8 during the same months in 2020. From January through April 2019, there was a 53% increase in transports, compared to a 42% decrease during the same months in 2020, constituting significantly different trend-line slopes (3.30; 95% CI 0.48–6.12 versus -3.70; 95% CI -5.76–-1.64, p = 0.001 ). Patient demographics, comorbidities, and symptom severity were mostly similar over the two time periods, and the number of patients with a final diagnosis of stroke was also similar. However, the median interval from EMS dispatch to ED arrival for patients with a final diagnosis of stroke was significantly longer in January to April 2020 ( 50 ± 11.7   min ) compared to the same time period in 2019 ( 42 ± 8.2   min , p = 0.01 ). Discussion/Conclusion. Our data indicate a decrease in patient transport volumes and longer intervals to EMS activation for suspected stroke care. These results suggest that even in a nonurban location without widespread community transmission, patients may be delaying or avoiding care for severe illnesses such as stroke. Clinicians and public health officials should not ignore the potential impact of pandemic-like illnesses even in areas of relatively low disease prevalence.

Abstract WP439: "You Gotta Troll to Enroll!" Nurses Actively Scouting Patients for Clinical Trials

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Betty Robertson ◽  
Denise Levesque ◽  
Nicole Wolber ◽  
Nili Steiner ◽  
Nancy Nunez ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Anticoagulation Therapy ◽  
Training Session ◽  
Stroke Care ◽  
Patient Identification ◽  
Stroke Team ◽  
Expert Nurses ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Patient Enrollment

Problem/ Background: Evidence- based practice is the cornerstone in delivery of stroke care to optimize outcomes for patients. Research is the foundation to build and advance clinical practice. As a Comprehensive Stroke Center, we are charged with participating in IRB approved research. In 2016 the SUCCEED trial was stopped here as a result of low enrollment. The stroke nurses were not directly involved in that trial. In 2017, the stroke nurses partnered with our physicians and began the ARAMIS trial. This is a multicenter study of acute stroke patients taking anticoagulation therapy prior to admission and suffering a stroke. We recognized the need for our stroke nurses to collaborate, participate and use their expertise in identifying appropriate research patients for this study. Quality Question: Will tasking Stroke Nurses with identifying patients improve the enrollment of patients in ARAMIS trial? Methods: Stroke nurses attended an ARAMIS training session for physicians. Included in the meeting was review of inclusion/exclusion criteria for patient enrollment. A group e-mail was created for all participating in the study to help identify potential patients. When a patient was discovered an email was sent to the group alerting those responsible for obtaining consent for the study and data collection for the registry. Results: After one trial was ended due to low enrollment, the new ARAMIS trial opened. The stroke team nurses took the lead on identifying patients. Reviewing retrospective data starting in November 2017 until March 2019, 56 patients were enrolled in Aramis. Stroke nurses identified 43 patients (77%), Neurology fellows 10 (18%) and Faculty physicians 3 (5%). Conclusion: When including expert nurses in the patient identification process, the nurse plays a pivotal role in identifying appropriate patient for the MDs to enroll, thus, increasing enrollment in clinical trials. While additional tracking and trending needs to take place as new trails open, this trial makes clear the need for nurse involvement in identifying appropriate patients.

Abstract TP303: Real-world Eligibility for Revascularization in Acute Stroke: A 12 Year Single Center Statistics

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Peter Vanacker ◽  
Dimitris Lambrou ◽  
Ashraf Eskandari ◽  
Patrik Michel
Keyword(s):  
Time Windows ◽  
Standard Of Care ◽  
Stroke Care ◽  
Regional Level ◽  
Effective Number ◽  
Single Center ◽  
Resource Needs ◽  
Liberal Approach ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Aims: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is the new standard of care for well selected, large vessel occlusive strokes. Hypothesis: We aimed to determine the frequency of patients potentially eligible for IV thrombolysis (IVT) and EVT based on the latest AHA/ASA guidelines. Methods: Data from a prespecified consecutive AIS registry (ASTRAL, 2003-2014) of a single comprehensive stroke center were examined. All AIS admitted <24hours and sufficient data to determine EVT-eligibility according to AHA/ASA guidelines (class I and IIa recommendations) on IVT and EVT were selected. Another set of more liberal criteria from different EVT trials and clinical practice was also tested. Time windows for EVT-eligibility was 4.5h (allowing for a door-to-groin delay ≤90min) and for IVT 3.5h (door-to-needle delay ≤60min). Results: A total of 2’704 AIS were included, of whom 26.8% were secondary transferrals. Proportion of IVT-eligible patients was 12.4% for all AIS, and 24.6% and 36.2% for patient arriving <24h and 6h respectively. Frequency of EVT-eligibility differed between the AHA/ASA guideline and the more liberal approach: 2.9% vs. 4.9% of all AIS and 10.5% vs. 17.7% of all patients arriving <6hours. These numbers are in line with the effective number of EVT applied in 2013 (15%) and 2014 (12%). Conclusions: Of patients arriving within 6h at a comprehensive stroke center, 10.5% are EVT eligible according to AHA/ASA criteria, nearly double (17.7%) with more liberal criteria, and again double for IV thrombolysis (36.2%). These figures may be useful for planning resource needs of stroke care on a regional level.

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