Inconsistent centralised versus non-centralised ischaemic stroke aetiology

Background and purposeThe Trial of Org 10 172 in Acute Stroke Treatment (TOAST) system is the most widely used aetiological categorisation system in clinical practice and research. Limited studies have validated the accuracy of routine aetiological diagnosis of patients with ischaemic stroke according to the TOAST criteria when the reported subtype is assumed to be correct. We investigated the agreement between centralised and non-centralised (site-reported, at discharge) stroke subtypes in the Third China National Stroke Registry (CNSR-III), and analysed the influence of classification consistency on evaluation during hospitalisation and for secondary prevention strategy.MethodsAll patients with ischaemic stroke from the CNSR-III study with complete diffusion-weighted imaging data were included. We used multivariable Cox proportional-hazard regression models to evaluate the factors associated with consistency between centralised and non-centralised stroke subtypes. Sensitivity analyses were conducted of the subgroup of patients with complete information.ResultsThis study included 12 180 patients (mean age, 62.3 years; and women, 31.4%). Agreement between centralised and non-centralised subtype was the highest for the large-artery atherosclerosis subtype stroke (77.4% of centralised patients), followed by the small-vessel occlusion subtype (40.6% of centralised patients). Agreements for cardioembolism and stroke of other determined aetiology subtypes were 38.7% and 12.2%, respectively. Patient-level and hospital-level factors were associated with the inconsistency between centralised/non-centralised aetiological subtyping. This inconsistency was related to differences in secondary prevention strategies. Only 15.3% of the newly diagnosed patients with cardioembolism underwent centralised subtyping with indications to receive oral anticoagulants at discharge. In comparison, 51.3% of the consistent cardioembolism group and 42.0% of the centrally reassigned cardioembolism group with anticoagulation indications were prescribed oral anticoagulants.ConclusionsSubstantial inconsistency exists between centralised and non-centralised subtyping in China. Inaccurate aetiological subtyping could lead to inadequate secondary prevention, especially in patients with cardioembolic stroke.

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Abstract TP184: Impact on Ischemic Stroke Subtypes of Fasting and Non-fasting Triglycerides

Stroke ◽

10.1161/str.48.suppl_1.tp184 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Jun Yup Kim ◽

Moon-Ku Han ◽

Kyung Bok Lee ◽

Keun-Sik Hong ◽

Yong-Jin Cho ◽

...

Keyword(s):

Ischemic Stroke ◽

Large Artery ◽

Lipid Levels ◽

Stroke Patients ◽

Vessel Occlusion ◽

Stroke Registry ◽

Stroke Subtypes ◽

Clinical Research Center ◽

Remnant Cholesterol ◽

Overnight Fasting

Introduction: Remnant cholesterol, comprising triglycerides(TG)-rich lipoproteins, accumulates in intimal foam cells and causes atherosclerosis. Fasting TG is reported to be associated with atherosclerotic stroke, but relationships between non-fasting TG (NFTG) and ischemic stroke subtypes are unknown. Recently NFTG was found to produce endothelial dysfunction. This study aimed to elucidate the association of fasting and NFTG with ischemic stroke subtypes, especially large-artery atherosclerosis (LAA) and small vessel occlusion (SVO). Methods: Using a prospective multicenter stroke registry (Clinical Research Center for Stroke - 5th division), we identified acute ischemic stroke patients, hospitalized within 48 hours of onset, and whose fasting and non-fasting TG values were available. We measured lipid profiles in each individual twice; at presentation and after overnight fasting. Initial TG were regarded as NFTG when measured within 8 hours from last mealtime. Results: Total 3,170 patients were analyzed. Stroke subtypes were categorized as LAA (37.9%), SVO (18.7%) and non-LAA and non-SVO (43.4%). Lipid levels according stroke subtypes are presented in Table. Lipid levels were divided by quartiles and the highest quartile was compared to others. In multinomial analyses compared to non-LAA and non-SVO group, fasting TG was associated with LAA (adjusted ORs 1.33 [95% CIs 1.09 - 1.62]) and SVO (1.61 [1.27 - 2.04]). NFTG was associated not with LAA (1.05 [0.87 - 1.28]), but with SVO (1.36 [1.08 - 1.71]). With respect to other lipid levels, fasting and non-fasting LDL were associated with both LAA (1.57 [1.29 - 1.90], fasting; 1.89 [1.56 - 2.29], non-fasting) and SVO (1.40 [1.11 - 1.77], fasting; 1.74 [1.38 - 2.19], non-fasting). Conclusions: This study may be the first one to demonstrate an association between non-fasting TG and SVO. It should be explored further on mechanisms of differential effect of fasting and non-fasting TG on ischemic stroke subtypes.

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Abstract TP227: Vascular Calcification, Atherosclerosis Burden, and Stroke Mechanism in Ischemic Stroke

Stroke ◽

10.1161/str.51.suppl_1.tp227 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Takashi Shimoyama ◽

Kunio Nakamura ◽

Sibaji Gaj ◽

Shivakrishna Kovi ◽

Ken Uchino

Keyword(s):

Ischemic Stroke ◽

Large Artery ◽

Stroke Patients ◽

Stroke Subtype ◽

Vessel Occlusion ◽

Stroke Registry ◽

Stroke Subtypes ◽

Toast Classification ◽

Stroke Mechanism ◽

Post Hoc

Background and Purpose: Calcification of the intracranial carotid artery is recognized as a risk factor for stroke in the general population. The significance of vascular calcifications in its relationship stroke mechanisms is incompletely understood. We hypothesized that vascular calcium quantification using CT angiography (CTA) can differ by stroke mechanism among ischemic stroke patients. Methods: From a prospective single-hospital stroke registry from 2018, we identified ischemic stroke patients who underwent CTA. Automatic artery and calcification segmentation method measured calcification volumes in the intracranial, extracranial, and aortic arteries using deep-learning U-net model and region-grow algorithms. Stroke subtypes were diagnosed based on the TOAST classification: large artery atherosclerosis (LAA), small vessel occlusion (SVO), cardioembolism (CE), others/undetermined. We evaluated the relationship between CTA calcification volume and stroke subtypes on one-way ANOVA and Tukey’s post-hoc test. Results: Of the 558 consecutive acute ischemic stroke patients, we enrolled 388 patients (212 males; mean age 66.6 years) in the study. Others/undetermined (34.8%) was the most frequent stroke subtype, followed by CE (29.4%), LAA (25.5%), and SVO (10.3%). The overall prevalence of atherosclerotic calcification was 95.9% in stroke patients. LAA had significantly higher calcification volume with 809 mm 3 compared to SVO (390 mm 3 , P=0.040), others/undetermined (300 mm 3 , P=0.001), but not CE (860 mm 3 , P=0.958). In age < 65 years subset, LAA showed higher calcification volume with 567 mm 3 than SVO (176 mm 3 , P=0.014), CE (213 mm 3 , P=0.021) and others/undetermined (180 mm 3 , P<0.001). There were no significant differences in calcification volume among stroke subtypes in age ≥65 years. Conclusion: Atherosclerotic calcium burden with a quantitative analysis of CTA images may be useful to differentiate stroke mechanism in younger patients.

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Abstract TP9: Safety of Endovascular Treatment in Acute Stroke Patients Taking Oral Anticoagulants

Stroke ◽

10.1161/str.47.suppl_1.tp9 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Timo Uphaus ◽

Oliver C Singer ◽

Joachim Berkefeld ◽

Christian H Nolte ◽

Georg Bohner ◽

...

Keyword(s):

Clinical Outcome ◽

Endovascular Treatment ◽

Acute Stroke ◽

Positive Impact ◽

Therapeutic Option ◽

Oral Anticoagulants ◽

Intravenous Thrombolysis ◽

Vessel Occlusion ◽

Stroke Treatment ◽

Male Patients

Introduction: The endovascular treatment (EVT) of cerebral ischemia in the case of large vessel occlusion has been established over recent years. Randomized trials showed a positive impact on the clinical outcome of endovascular treatment in addition to thrombolysis with respect to clinical outcome and safety, so that this therapeutic option will be implemented in future guidelines. The role of EVT in patients treated with oral anticoagulants remains uncertain. Hypothesis: We assessed the hypothesis that application of EVT is safe with regard to the occurrence of intracranial bleeding and clinical outcome in patients taking anticoagulants. Methods: The ENDOSTROKE-Registry is a commercially independent, prospective observational study in 12 stroke centers in Germany and Austria launched in January 2011. An online tool served for data acquisition of pre-specified variables concerning endovascular stroke therapy. Results: Data from 815 patients (median age 70, 57% male) undergoing EVT and known anticoagulation status were analyzed. A total of 85 (median age 76, 52% male) patients (10.4%) took oral anticoagulants prior to EVT. Anticoagulation status as measured with INR was 2.0-3.0 in 24 patients (29%), <2.0 in 52 patients (63%) and above 3.0 in 7 patients (8%) of 83 patients with valid INR data prior to EVT. Patients taking anticoagulants were significantly older (median age 76 vs. 69, p < 0.001). Comparing those patients taking anticoagulants and those not, there were no differences concerning NIHSS at admission (with anticoagulants Median-NIHSS 17 vs. without Median-NIHSS 15, p = 0.492, Mann Whitney Test) and the rate of intracranial hemorrhage after intervention (with anticoagulants 11.8% vs. without 12.2%, p = 0.538). After adjustment for age and NIHSS at admission there were no significant differences between the two groups with regard to good clinical outcome, as measured with the modified ranking scale (mRS, 90d-mRS 0-2, 39.2% of patients not receiving anticoagulants; 25.9% of those receiving anticoagulants). Conclusion: The application of endovascular treatment in patients taking oral anticoagulants is safe and should be considered in acute stroke treatment as an important alternative to contraindicated intravenous thrombolysis.

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Abstract P252: Discharge Antithrombotic Therapy for Ischemic Stroke Patients With Prior Aspirin Failure

Stroke ◽

10.1161/str.52.suppl_1.p252 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ying Xian ◽

Haolin Xu ◽

Deepak L Bhatt ◽

Gregg C Fonarow ◽

Eric E Smith ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Prevention ◽

Antithrombotic Therapy ◽

Recurrent Stroke ◽

Oral Anticoagulants ◽

The United States ◽

Future Research ◽

Large Artery ◽

Secondary Stroke Prevention ◽

Stroke Registry

Introduction: Aspirin is one of the most commonly used medications for cardiovascular disease and stroke prevention. Many older patients who present with a first or recurrent stroke are already on aspirin monotherapy, yet little evidence is available to guide antithrombotic strategies for these patients. Method: Using data from the American Heart Association Get With The Guidelines-Stroke Registry, we described discharge antithrombotic treatment pattern among Medicare beneficiaries without atrial fibrillation who were discharged alive for acute ischemic stroke from 1734 hospitals in the United States between October 2012 and December 2017. Results: Of 261,634 ischemic stroke survivors, 100,016 (38.2%) were on prior aspirin monotherapy (median age 78 years; 53% women; 79.4% initial stroke and 20.6% recurrent stroke). The most common discharge antithrombotics (Figure) were 81 mg aspirin monotherapy (20.9%), 325 mg aspirin monotherapy (18.2%), clopidogrel monotherapy (17.8%), and dual antiplatelet therapy (DAPT) of 81 mg aspirin and clopidogrel (17.1%). Combined, aspirin monotherapy, clopidogrel monotherapy, and DAPT accounted for 86.8% of discharge antithrombotics. The rest of 13.2% were discharged on either aspirin/dipyridamole, warfarin or non-vitamin K antagonist oral anticoagulants with or without antiplatelet, or no antithrombotics at all. Among patients with documented stroke etiology (TOAST criteria), 81 mg aspirin monotherapy (21.2-24.0%) was the most commonly prescribed antithrombotic for secondary stroke prevention. The only exception was those with large-artery atherosclerosis, in which, 25.3% received DAPT of 81 mg aspirin and clopidogrel at discharge. Conclusion: Substantial variations exist in discharge antithrombotic therapy for secondary stroke prevention in ischemic stroke with prior aspirin failure. Future research is needed to identify best management strategies to care for this complex but common clinical scenario.

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Abstract 3884: Stroke Subtypes in Hispanic Patients in the NINDS Stroke Genetics Network (SiGN): A Comparison of Two Classification Systems

Stroke ◽

10.1161/str.43.suppl_1.a3884 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Michael Katsnelson ◽

Tatjana Rundek ◽

Ralph Sacco ◽

Hannah Gardener ◽

Shaneela Malik ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Classification Systems ◽

Blood Collection ◽

Large Artery ◽

Stroke Subtype ◽

Reliable Determination ◽

Stroke Treatment ◽

Stroke Subtypes ◽

Small Artery Occlusion

Objectives: Identification of gene variants of stroke subtypes is important for the development of tailored ischemic stroke therapies among various ethnic groups. Valid and reliable determination of ischemic stroke subtype is essential for achieving this goal and to standardize a classification scheme across multi-center studies and different populations. Causative Classification System for Ischemic Stroke (CCS) is a novel computerized subclassification tool developed to improve reliability and accuracy of classifying stroke types. The CCS algorithm relies on both phenotypic and causative stroke variables. A Hispanic subset of the SiGN, an important and distinct target population with greater risk of certain stroke subtypes, was evaluated with Trial of Org 10172 in Acute Stroke Treatment (TOAST) and CCS and the agreement between the two classification systems was analyzed. Methods: Over 6000 subjects at 15 sites across US and Europe were enrolled, with TOAST and CCS locally adjudicated. Blood collection and central data quality control (10% central readjudication) were performed on all participants. A subset of Hispanics was analyzed for the purpose of this study and the agreement between the TOAST and CCS were assessed by kappa statistic. Findings: Hispanics (n=595, 10.9%) compared to non-Hispanics (n=5457) were more likely to be younger (63.7 vs. 64.0), male (55% vs. 46%) and have fewer of the traditional stroke risk factors HTN (54% vs. 64%), Afib (11% vs. 14%), DM(23% vs. 25%), CAD(16% vs. 20%) and smoking(19% vs. 22%). While the TOAST showed no differences between stroke subtypes for Hispanic vs. non-Hispanics, in CCS, Hispanics were classified with more of large vessel (22% vs. 20%), cardioembolic (37% vs. 30%) and small vessel strokes (13% vs. 9%) and fewer with undetermined etiology (28% vs. 40%) as compared to non-Hispanics. TOAST and CCS offered moderate correlation across all stroke types in Hispanics: kappa of 0.66 for large artery atherosclerosis, 0.58 for cardioembolic, and 0.58 for small artery occlusion. Conclusion: CCS offers a more sensitive and accurate system for subphenotyping of strokes in Hispanics who tended to have relatively fewer risk factors and unclassified strokes. Further studies correlating the two classification systems and their relation to genotyping data are warranted.

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Characteristics and management of stroke in Korea: 2014–2018 data from Korean Stroke Registry

International Journal of Stroke ◽

10.1177/1747493019884517 ◽

2019 ◽

Vol 15 (6) ◽

pp. 619-626 ◽

Cited By ~ 2

Author(s):

Han-Yeong Jeong ◽

Keun-Hwa Jung ◽

Heejung Mo ◽

Chan-Hyuk Lee ◽

Tae Jung Kim ◽

...

Keyword(s):

Risk Factors ◽

Reperfusion Therapy ◽

Lifestyle Changes ◽

Large Artery ◽

Stroke Subtype ◽

Vessel Occlusion ◽

Stroke Registry ◽

Aging Populations ◽

Care Patterns ◽

Ischemic Attack

Background Lifestyle changes and evolving healthcare practices in Korea have influenced disease patterns and medical care. Since strokes have high disease burden in countries with aging populations, it is necessary to evaluate the associated recent disease characteristics and patient care patterns. The Korean Stroke Registry is a nationwide, multicenter, prospective, hospital-based stroke registry in Korea used to monitor these changes across the population. Aims We aimed to evaluate the recent status of clinical characteristics and management of stroke cases in order to identify changes in the Korean population across time. Methods This study used Korean Stroke Registry data from patients experiencing ischemic stroke or transient ischemic attack patients, between 2014 and 2018. We analyzed data on demographics, risk factors, stroke subtypes, and treatments that included thrombolysis. Results A total of 39,291 patients (mean age 68.0 ± 13.0, 58.3% male) were analyzed. The proportions of hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, and prior stroke were 63.4%, 30.9%, 27.7%, 19.4%, and 17.1%, respectively. In the stroke subtype analysis, the frequency of large artery atherosclerosis was highest (32.6%), followed by cardioembolism (21.3%) and small vessel occlusion (19.9%). Acute reperfusion therapy was conducted in 15.3% of cases (11.7% using intravenous tPA and 7.3% using intra-arterial thrombectomy). Intra-arterial thrombectomy also demonstrated a steep increasing trend over time (RR 1.095 (1.060–1.131), p < 0.001). Conclusions This study provided analysis of nationwide, hospital-based, quality-controlled data from the Korean Stroke Registry database regarding changes in the characteristics, risk factors, and treatments of strokes in Korea.

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Concurrent intracranial and extracranial artery stenosis and the prognosis of transient ischaemic symptoms or imaging-negative ischaemic stroke

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000377 ◽

2020 ◽

pp. svn-2020-000377

Author(s):

Yue Suo ◽

Jing Jing ◽

Yuesong Pan ◽

Weiqi Chen ◽

Hongyu Zhou ◽

...

Keyword(s):

Ischaemic Stroke ◽

Cox Regression ◽

Recurrent Stroke ◽

Time Interval ◽

Symptom Duration ◽

Large Artery ◽

Imaging Data ◽

Vascular Events ◽

Acute Infarction ◽

Atherosclerotic Stenosis

Background and purposeTransient ischaemic attack (TIA), transient symptoms with infarction (TSI) and diffusion-weighted imaging (DWI)-negative acute ischaemic stroke (AIS) share similar aetiologies but are considered to have a rather benign prognosis. We intended to investigate the association between intracranial atherosclerotic stenosis (ICAS), extracranial atherosclerotic stenosis (ECAS) and the prognosis of patients with TIA, TSI and DWI-negative AIS.MethodsClinical and imaging data of eligible participants were derived from the Chinese Intracranial Atherosclerosis study, according to symptom duration, acute infarction on DWI and discharge diagnosis. Based on the severity and location of arterial atherosclerosis, we categorised the study population into four groups: no or <50% ICAS and no ECAS; ≥50% ICAS but no ECAS; no or <50% ICAS with ECAS; and concurrent ≥50% ICAS and ECAS. Using multivariable Cox regression models, we analysed the relationship between the severity and distribution of large artery atherosclerosis and the prognosis of TIA, TSI and DWI-negative AIS.ResultsA total of 806 patients were included, 67.3% of whom were male. The median age of the study participants was 63 years. Patients in the concurrent ≥50% ICAS and ECAS subgroup had both a significantly higher 1-year recurrence rate (adjusted HR 3.4 (95% CI 1.15 to 10.04), p=0.027) and a higher risk of composite vascular events (adjusted HR 3.82 (95% CI 1.50 to 9.72), p=0.005).ConclusionsConcurrent ICAS and ECAS is associated with a higher possibility of 1-year recurrent stroke or composite vascular events. Large artery evaluation is necessary to assess patients with transient ischaemic symptoms or DWI-negative AIS. Progress in shortening the time interval between symptom onset and large vessel evaluation is needed.

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A porous circulation model of the human brain for in silico clinical trials in ischaemic stroke

Interface Focus ◽

10.1098/rsfs.2019.0127 ◽

2020 ◽

Vol 11 (1) ◽

pp. 20190127 ◽

Cited By ~ 2

Author(s):

T. I. Józsa ◽

R. M. Padmos ◽

N. Samuels ◽

W. K. El-Bouri ◽

A. G. Hoekstra ◽

...

Keyword(s):

Clinical Trials ◽

Human Brain ◽

Ischaemic Stroke ◽

In Silico ◽

Circulation Model ◽

Vessel Occlusion ◽

Anisotropic Permeability ◽

Stroke Treatment ◽

Computed Tomography Images ◽

Human Experiments

The advancement of ischaemic stroke treatment relies on resource-intensive experiments and clinical trials. In order to improve ischaemic stroke treatments, such as thrombolysis and thrombectomy, we target the development of computational tools for in silico trials which can partially replace these animal and human experiments with fast simulations. This study proposes a model that will serve as part of a predictive unit within an in silico clinical trial estimating patient outcome as a function of treatment. In particular, the present work aims at the development and evaluation of an organ-scale microcirculation model of the human brain for perfusion prediction. The model relies on a three-compartment porous continuum approach. Firstly, a fast and robust method is established to compute the anisotropic permeability tensors representing arterioles and venules. Secondly, vessel encoded arterial spin labelling magnetic resonance imaging and clustering are employed to create an anatomically accurate mapping between the microcirculation and large arteries by identifying superficial perfusion territories. Thirdly, the parameter space of the problem is reduced by analysing the governing equations and experimental data. Fourthly, a parameter optimization is conducted. Finally, simulations are performed with the tuned model to obtain perfusion maps corresponding to an open and an occluded (ischaemic stroke) scenario. The perfusion map in the occluded vessel scenario shows promising qualitative agreement with computed tomography images of a patient with ischaemic stroke caused by large vessel occlusion. The results highlight that in the case of vessel occlusion (i) identifying perfusion territories is essential to capture the location and extent of underperfused regions and (ii) anisotropic permeability tensors are required to give quantitatively realistic estimation of perfusion change. In the future, the model will be thoroughly validated against experiments.

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Subtypes, Risk Factors and Site of Stenosis of Ischaemic Stroke in a University Hospital in Bangladesh

Borneo Journal of Medical Sciences (BJMS) ◽

10.51200/bjms.vi.2453 ◽

2021 ◽

pp. 11

Author(s):

Mohammad Shahidullah ◽

Nahid Sultana ◽

Subash Kanti Dey ◽

Anis Ahmed

Keyword(s):

Risk Factors ◽

Magnetic Resonance ◽

Ischaemic Stroke ◽

Cross Sectional Study ◽

University Hospital ◽

Large Artery ◽

Stroke Patients ◽

Vessel Occlusion ◽

Cross Sectional ◽

Common Cause

Stoke is the second most common cause of death and the most common cause of adult disability. To plan an efficient evaluation and treatment of an individual patient with ischaemic stroke, the clinician should be familiar with the subtyping of ischaemic stroke patients and the risk factors analysis of different aetiology. Eight hundred seventy-seven (877) patients have been selected for this cross-sectional study conducted in a university hospital of Bangladesh from 2014 to 2018, to whom brain imaging [Computed Tomography (CT)/ Magnetic Resonance Imaging (MRI)], vascular imaging [Magnetic Resonance Angiogram (MRA), Digital Subtraction Angiogram (DSA)], ECG and echocardiography have been done. We did subtyping according to TOAST criteria. The mean age of patients was 60.5 ± 11 years. Most patients (29.33%) belonged to the age group 51 – 60, where 70.47% of subjects were male and 29.53% were female. In this study, 43.87% of patients were in the large artery atherosclerosis group, 23.83.% in the small vessel occlusion group, 8.46% in the cardiac embolism group, 19.30% in the undetermined aetiology group and 4.54% in other determined aetiology. Among risk factors hypertension, diabetes mellitus, dyslipidaemia was present in 58.15%, 38.42%, and 38.88% of patients, respectively. In ischaemic stroke patients, large artery atherosclerosis was the most common subtype and hypertension was significant in this group. Extracranial stenosis was more common in ischaemic stroke.

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Endovascular treatment of ischaemic stroke patients - new evidence and old challenges

VASA ◽

10.1024/0301-1526/a000537 ◽

2016 ◽

Vol 45 (4) ◽

pp. 267-274 ◽

Cited By ~ 1

Author(s):

Johannes Gerber ◽

Volker Puetz ◽

Ulf Bodechtel ◽

Hagen Kitzler ◽

Ruediger von Kummer ◽

...

Keyword(s):

Ischaemic Stroke ◽

Endovascular Treatment ◽

Standard Of Care ◽

Interdisciplinary Cooperation ◽

Evidence Based ◽

Large Vessel Occlusion ◽

Stroke Patients ◽

Vessel Occlusion ◽

Stroke Treatment ◽

New Evidence

Abstract. An overwhelming benefit from endovascular treatment of ischaemic stroke could be shown in recent clinical trials, making it the new evidence-based standard of care for ischaemic stroke due to large vessel occlusion. To provide all eligible stroke patients with this therapy at any time, stroke networks and hospitals should streamline their workflow to rapidly image, select, and treat stroke patients. Interdisciplinary cooperation is vital for effective emergency endovascular stroke treatment, which is one of the most complex multidisciplinary functions a hospital can undertake.

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