Pre- and interhospital workflow in large vessel occlusion stroke

The aim of the research projects described in this thesis was to improve the pre- and interhospital workflow for patients with large vessel occlusion (LVO) stroke, in order to shorten time to treatment with endovascular thrombectomy (EVT) and thereby improve clinical outcome. In the first part of this thesis, we focused on improving the current ‘drip-and-ship’ workflow, in which patients are often first presented to a primary stroke center and subsequently transferred to a comprehensive stroke center for EVT. We found that this workflow can be substantially improved by implementing some relatively simple measures, such as standard ambulance dispatch with the highest level of urgency for EVT transfers and refraining from repetition of neuroimaging at the comprehensive stroke center in patients with neurological deterioration. These two measures can decrease time to treatment by 28 and 20 minutes, respectively. In the second part of this thesis, we shifted our focus to the workflow that we envision for the future: prehospital LVO detection enabling paramedics to transport patients with LVO stroke directly to a comprehensive stroke center. We outlined the necessary characteristics of an efficient prehospital LVO detection method, discussed previously studied methods, and proposed electroencephalography (EEG) as a potentially suitable instrument for this purpose. We described the preliminary results of our diagnostic accuracy study, which indicate that dry electrode EEG can detect LVO stroke with fairly high accuracy. However, signal quality needs to be improved and validation in the prehospital setting is necessary.