Acute stroke: from triage to treatment

Abstract

Stroke remains a leading cause of disability and death worldwide. Rapid recognition and treatment are crucial, as the effectiveness of reperfusion therapies declines over time. This thesis focused on optimizing prehospital triage of patients with suspected stroke and acute treatment of ischemic stroke with endovascular thrombectomy.

In the prehospital phase, multiple stroke and large-vessel occlusion scales were compared to improve patient detection while minimizing overtriage. Additionally, the potential of a large-vessel occlusion scale for identifying intracerebral hemorrhage was assessed, which may become increasingly relevant if new interventions for these patients prove effective. Furthermore, differences between paramedic and physician assessments were evaluated, highlighting the need for targeted EMS training on specific symptoms to improve triage accuracy.

Regarding acute treatment, endovascular thrombectomy was shown to be safe and effective even beyond the conventional 6-hour time window in patients selected without mandatory CT perfusion imaging. Moreover, achieving near-complete reperfusion (eTICI ≥2C) best predicted favorable outcomes, redefining technical success benchmarks for endovascular thrombectomy.

Together, these findings support a shift toward more pragmatic, inclusive, and data-driven triage and treatment strategies, integrating clinical assessment, imaging, and emerging technologies to improve timely and equitable stroke care.