Innovations in Care Delivery of Stroke From Emergency Medical Services to the Neurointerventional Operating Room

Neurosurgery. 2019 Jul 1;85(suppl_1):S18-S22. doi: 10.1093/neuros/nyz021.


Acute ischemic stroke (AIS) and its care is currently one of the most dynamic and evolving illnesses across the globe. Among the most crucial factors in providing the best care to patients are the expedient delivery of thrombolytics and endovascular intervention when indicated. Here, we review our unique model of efficient care centered in our innovative Neurological Emergency Department (Neuro ED). The Neuro ED acts as our hub for EMS communication, imaging, administration of intravenous alteplase, and transition to the Neurointerventional OR. Our structure with its enabling of shortened IV alteplase delivery times and faster door-to-needle (DTN) times may serve as an international model for stroke centers.

Keywords: Alteplase; Emergency medical services (EMS); Neurological emergency department; Stroke; Thrombectomy.

MeSH terms

  • Aged
  • Brain Ischemia / therapy*
  • Delivery of Health Care / methods
  • Delivery of Health Care / organization & administration
  • Emergency Medical Services / methods*
  • Emergency Medical Services / organization & administration*
  • Emergency Service, Hospital / organization & administration
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Humans
  • Male
  • Operating Rooms / organization & administration
  • Stroke / therapy*
  • Thrombolytic Therapy / methods
  • Time-to-Treatment / organization & administration*
  • Tissue Plasminogen Activator / administration & dosage


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator