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A review of acute ischemic stroke triage protocol evidence: a context for discussion
  1. Alexander G Chartrain1,
  2. Hazem Shoirah1,
  3. Edward C Jauch2,
  4. J Mocco1
  1. 1 Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, USA
  2. 2 Departments of Emergency Medicine and Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr. J Mocco; j.mocco{at}, j.mocco{at}


Endovascular thrombectomy (EVT) is now the standard of care for eligible patients with acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (ELVO). However, there remains uncertainty in how hospital systems can most efficiently route patients with suspected ELVO for EVT treatment. Given the relative geographic distribution of centers with and without endovascular capabilities, the value of prehospital triage directly to centers with the ability to provide EVT remains debated. While there are no randomized trial data available to date, there is substantial evidence in the literature that may offer guidance on the subject. In this review we examine the available data in the context of improving the existing AIS triage systems and discuss how prehospital triage directly to endovascular-capable centers may confer clinical benefits for patients with suspected ELVO.

  • stroke

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  • Contributors All authors contributed to the manuscript through manuscript composition and critical review. All authors provided final approval for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.