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Getting ahead of stroke
  1. William J Mack
  1. Department of Neurosurgery, Keck School of Medicine of USC Los Angeles, Los Angeles, CA 90033, USA
  1. Correspondence to Dr William J Mack, Department of Neurosurgery, Keck School of Medicine of USC Los Angeles, Los Angeles, CA 90033, USA; William.Mack{at}

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In 2015, multiple randomized controlled trials clearly demonstrated that mechanical thrombectomy could save lives and prevent disability in patients with large vessel acute ischemic stroke. Neurointerventional surgeons and stroke neurologists celebrated a great win for our patients. We soon realized, however, that the hard work of implementation lay ahead. Hospitals and emergency medical services (EMS) were not optimally designed to ensure that patients with a stroke were brought to the right hospital rather than the closest one. These shortcomings resulted in patients unnecessarily being transferred between hospitals to receive optimal stroke care, or worse, never presenting to a hospital capable of treating their large vessel stroke with standard of care.

Efficient prehospital pathways and protocols are critical to the outcomes of patients with large vessel strokes. We know that “time is brain”.1–3 Direct routing of patients with a large vessel stroke to endovascular capable centers can lead to better clinical outcomes by earlier vessel recanalization and tissue reperfusion through mechanical thrombectomy.4–6 Stroke progression has been shown to vary according to the prehospital pathway, with more pronounced infarct volumes in transferred patients.7 Studies have shown that hospital-level stroke thrombectomy volumes are associated with patient outcomes.8 Efficient identification and appropriate triage of stroke patients to level 1 stroke centers that offer a full the full spectrum of neuroendovascular therapies is essential.

Advocacy on behalf of our patients is critical to ensuring that they have the best access to appropriate triage, transport, and treatment. In 2016, the Society of Neurointerventional Surgery (SNIS) founded Get Ahead of …

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  • Contributors I am the sole contributor.

  • 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.

  • Provenance and peer review Commissioned; internally peer reviewed.