Ischemic Stroke: Faster Treatment Requires Better Logistics

The type of blood clot that causes the most damage is an ischemic stroke, which occurs when a blood clot gets stuck in an artery. Every minute counts, and while proven treatments – including drugs and procedures – are available, they take time. Now, as medical teams hurry to help stroke patients, the pre-hospital and hospital systems are grappling with operational challenges.

Why It Matters

There is a need for current estimates of stroke incidence in adults in the United States. First ischemic stroke incidence rates and recurrent ischemic stroke incidence rates both exceed 200 new cases per 100,000 persons per year. More than 9 million American adults 20 years and older report that they have had a history of stroke; this translates to a prevalence of 3.3%. This number is projected to increase by more than 20% to 12.9 million adults with a history of stroke by 2030, representing nearly 4% of the U.S. adult population. However, stroke incidence is not randomly distributed throughout the adult population. Adversity related to a number of sociospatial and socioeconomic characteristics, including economic instability, less than a high school education, uncertainty about negative neighborhood change, and residence within the U.S. Stroke Belt, is associated with disproportionately high rates of stroke incidence. Ischemic strokes are the most prevalent form of stroke and are responsible for more than 80% of all stroke cases in the United States and greater than 60% worldwide.

Morbidity and Mortality

Stroke is a common condition which is very severe for both mortality and disability with more than 50% of patients surviving for more than 6 months with some disability requiring assistance with activities of daily living. Gradual deterioration in cognitive function often results from recurrent strokes and overall increase in brain damage. Stroke incidence, stroke mortality, and resulting disability all have the effect of maintaining and creating health outcome disparities and inequities, particularly for individuals experiencing adverse social and medical disabilities and low socioeconomic status.

Every Second Counts

Every minute of delay in supplying the brain with oxygen results in loss of brain function, and rapid diagnosis and treatment are key to reduced disability, shorter hospital stay, and quicker return to independence. Yet, speed to treatment is not only a clinical issue, but a systems and logistics issue. Ambulance routing, emergency dispatch protocols, hospital imaging processes, in hospital treatment protocols, hospital transfer decisions, and post-acute care processes can all affect speed and effectiveness of stroke treatment.

Clinicians and Healthsystems

Staggering treatment speed changes what clinicians and health system leaders are trying to do to deliver fast care, and how they might staff, invest in capital and technology, and measure quality. Most importantly, it raises important tradeoffs between the potential increased cost and complications from rapidly treating ill patients with uncertain or incorrect diagnoses, versus the potential long-term benefits to patient and family of faster care. Policymakers and payers will be particularly interested in these tradeoffs as they decide where to invest in system redesign and technology (e.g. ambulances traveling faster).

Speed to treatment from the patient’s perspective is important. However, long-term, speed to treatment is also important because it determines the likelihood of the patient being left with disability, the likelihood that the patient will require care in a facility, and the likelihood that treatment will place a substantial burden on the patient’s family in terms of direct and indirect costs. Speed to treatment is also critical when thinking about issues of equity and inequality. How can communities with no close-by stroke ready hospitals, or no neurologists on call, or with long ambulance response times improve outcomes for stroke patients unless we re-think the current logistics of how we deliver stroke care?

Who It Affects

Patients

This program can also aid in the diagnosis and management of patients with acute neurologic conditions, such as sudden weakness of face or arm/leg, sudden difficulty speaking or understanding speech, sudden drooping of one side of the face, sudden vision loss, and severe headache. These patients are at increased risk for stroke, and studies have shown that patients with stroke-like symptoms have longer transport times and less access to care in rural settings. Thus, each minute counts in the evaluation and treatment of these patients. Older adults and those with risk factors for cardiovascular disease are also more likely to experience a stroke.

Emergency Personnel

This poster will outline the steps required for all individuals in the stroke care continuum to ensure the patient receives optimal treatment. The first group to interact with the patient are the EMS personnel and the dispatchers. Both must be able to identify a stroke, expedite transport to the hospital, and inform the receiving hospital that a patient with a possible stroke is en route and may require treatment upon arrival. Once the patient is in the care of the stroke center, the emergency physician, neurologist, radiologist, interventionalist and the nursing staff must all work together to evaluate the patient, obtain imaging and determine a treatment plan in a timely manner.

Healthsystems

Hospitals and health systems – particularly those that serve as transfer centers – are feeling a lot of pressure regarding their choices for providing imaging services, designing stroke pathways and educating their physicians. All stakeholders are looking to hospital administrators for answers – payers and policymakers wanting to understand the cost savings of different logistical models, families and caregivers wanting best patient care. As the reimbursement landscape shifts, the impact on quality metrics and patient certification must also be considered. How will decisions affect regional planning efforts?

What Changes

• Pre-hospital triage and routing: EMS protocols that identify likely large-vessel occlusions and bypass nearer hospitals in favor of comprehensive stroke centers can cut time to definitive care, but they require reliable pre-hospital assessment tools and regional agreements to avoid overwhelming specialized centers.
• Coordination and data flow: Real-time communication between ambulances and hospitals, standardized stroke alert activations, and shared imaging platforms let in-hospital teams prepare for incoming patients and shorten door-to-treatment intervals.
• Expanded telemedicine and workforce solutions: Telestroke networks and on-call remote specialists extend expertise to hospitals without in-person neurologists, improving access in rural areas and off-hours while reducing unnecessary transfers.
• Technology and process innovations: Mobile stroke units with on-board imaging, point-of-care testing, and decision-support tools can accelerate diagnosis; within hospitals, designated stroke pathways, rapid-sequence imaging, and streamlined consent processes reduce delays while preserving safety.

Clinical and Operational Considerations

In managing ischemic stroke, timing is everything, but there are also patients for whom a more cautious diagnostic evaluation prior to initiation of anticoagulation therapy might be appropriate. While administration of intravenous thrombolysis (tPA) must be accomplished expeditiously, it is not without risk of hemorrhage. Endovascular thrombectomy (EVT) for selected patients with large artery occlusion is very effective, but can only be accomplished expeditiously if there is ready access to competent teams and high-field imaging. Clinician’s judgment aided by simple triage tools and imaging is important to determine which patients might benefit from tPA versus EVT.

New Guideline

The American Heart Association (AHA) and the American Stroke Association (ASA) have published the updated 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke. The writers of the guideline include a mix of vascular neurologists, neuro-interventionalists, emergency physicians, neurosurgeons and neurocritical care physicians. A nurse scientist and patient representatives also contributed to the writing of the new guideline.

2026 AHA/ASA Acute Ischemic Stroke (AIS) Guidelines: What Neurointerventional Surgeons and Endovascular Therapists Need to Know.