Implementation Challenges of Regionalized Acute Stroke Care

Abstract

Almost a quarter of a century has passed since the National Institute of Neurological Disorders and Stroke (NINDS) tPA trial began to transform the emergency treatment of acute ischemic stroke (AIS), based on a rigid 3 hour window from the patient's last known well (LKW) time. Twenty years later, the mechanical thrombectomy era was ushered in by compelling outcome data from trials of large vessel occlusion (LVO) AIS patients selected for mechanical thrombectomy within 4.5 hours from LKW, based on CT perfusion (CTP) and magnetic resonance imaging mismatch criteria.

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