TY - JOUR T1 - Prehospital care delivery and triage of stroke with emergent large vessel occlusion (ELVO): report of the Standards and Guidelines Committee of the Society of Neurointerventional Surgery JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 802 LP - 812 DO - 10.1136/neurintsurg-2016-012699 VL - 9 IS - 8 AU - G Lee Pride AU - Justin F Fraser AU - Rishi Gupta AU - Mark J Alberts AU - J Neal Rutledge AU - Ray Fowler AU - Sameer A Ansari AU - Todd Abruzzo AU - Barb Albani AU - Adam Arthur AU - Blaise Baxter AU - Ketan R Bulsara AU - Michael Chen AU - Josser E Delgado Almandoz AU - Chirag D Gandhi AU - Don Heck AU - Steven W Hetts AU - Joshua A Hirsch AU - M Shazam Hussain AU - Richard Klucznik AU - Seon-Kyu Lee AU - William J Mack AU - Thabele Leslie-Mazwi AU - Ryan A McTaggart AU - Philip M Meyers AU - J Mocco AU - Charles Prestigiacomo AU - Athos Patsalides AU - Peter Rasmussen AU - Robert M Starke AU - Peter Sunenshine AU - Donald Frei AU - Mahesh V Jayaraman A2 - , Y1 - 2017/08/01 UR - http://jnis.bmj.com/content/9/8/802.abstract N2 - Recent randomized clinical trials1–5 established the superiority of endovascular recanalization techniques, specifically mechanical embolectomy, compared with best medical therapy alone for the treatment of patients with emergent large vessel occlusion (ELVO) stroke. ELVO stroke is defined as a stroke secondary to anterior circulation large vessel occlusion (LVO) of the internal carotid, middle cerebral (M1 segments) arteries documented by imaging, without large completed infarct and presenting within 6 hours of symptom onset.6 Given the overwhelming clinical evidence provided by these trials, recent American Heart Association (AHA) guidelines concluded that “embolectomy needs to be performed as rapidly as possible for the greatest clinical benefit, and is best when performed within 6 h from onset of symptoms” (AHA class I, level of evidence A).6 In addition, cost modeling derived from trial outcomes data and claims databases in the USA strongly suggests that cost-effectiveness and an overall societal benefit is associated with investment in access to these endovascular techniques.7 Rapid access to endovascular services depends upon optimization of prehospital stroke care and transport within stroke systems of care, focusing on the unique needs of patients with ELVO through their diagnostic investigation and treatment pathway. The Society of NeuroInterventional Surgery (SNIS) proposed process time metrics for ELVO stroke treatment, including door to IV tissue plasminogen activator (t-PA) of <30 min, comprehensive stroke center (CSC) door to puncture of <60 min, CSC door to recanalization of <90 min and primary stroke certification (PSC) picture to CSC puncture of <90 min.8 Early team awareness of the patient with potential ELVO, coupled with efficient interdisciplinary communication, triage and transport assist in meeting these ideal time metrics, and also contribute to improved clinical outcomes through efficiency gains and maximization of endovascular care delivery.The Standards and Guidelines Committee of the SNIS, a multidisciplinary society representing leaders in the field of … ER -