Delay AvoIding Primary Evaluation for ThRombectomy of Acute StrokE Patients With Large Vessel OCclusion in the Angiography SuiTe

Other illness

• Hemorrhagic Stroke: Presence of intracranial hemorrhage on brain imaging in the conventional strategy as Heidelberg that renders thrombectomy contraindicated.

Other

• An individual who meets any of the following criteria will be excluded from participation in the trial:
• Time Restrictions: Presentation to a thrombectomy-capable center more than 7 hours from LSW.
• Imaging Criteria for Interfacility Transfer Patients: At sites enrolling transfer patients, any patient arriving from an outside hospital with time from imaging study at the presenting hospital to arrival at the TSC not exceeding 90 minutes.

• To be eligible for participation in the DIRECT trial, an individual must meet all of the following criteria:
• Age: ≥ 18 years of age.
• Clinical Presentation: Present to a participating TSC with signs or symptoms suggestive of acute LVO stroke.
• Stroke Severity: Baseline NIHSS of 10 or higher.
• Time since LKW: Time from LKW to arrival at the TSC must be within 7 hours.
  • Additional criteria
  • For all Interfacility Transfers:
  • 1\. If imaging was performed at the outside facility, the time from the first imaging to arrival at the thrombectomy center must exceed 90 minutes.
  • For all the Conventional Triage Arm, participants must also meet the following criteria:
• Presence of a qualifying LVO by CTA or MRA imaging; or
• For Large Core Patients: Patients with large core infarcts (CT-ASPECT score ≤ 5, DWI-ASPECT score ≤ 5, or infarct volume ≥ 70 cc) will be enrolled, irrespective of treatment decisions regarding embolectomy.
  • For all DTAS Arm:
  • 1\. Patients who do not have LVO occlusions in the angiography suite assessment (ICH, distal occlusions or mimics) will be enrolled, irrespective of treatment decisions regarding embolectomy.