Milestones of Acute ischaemic stroke care: real-life evidence on the impact of AI-based decision-support, COVID-19 pandemic and of extension of the therapeutic time windows for acute reperfusion therapies
Takács Tímea Tünde
János Szentágothai Neurosciences
Dr. Bereczki Dániel
SE Neurológiai Klinika előadóterme
2025-04-29 14:30:00
Clinical Neurological Research
Dr. Kovács Tibor
Dr. Gunda Bence Barna
Dr. Fenyves Bánk
Dr. Csécsei Péter
Dr. Réthelyi János
Dr. Terebessy András
Dr. Annus Ádám
Stroke is a leading cause of mortality and disability worldwide, contributing significantly to the global burden of disease. The economic impact of stroke in the EU is substantial, with high costs related to healthcare, social services, and lost productivity. Despite advancements in acute stroke therapies, only a small percentage of AIS patients receive IVT or EVT, which are the most effective treatments, only available in the acute phase. The extension of therapeutic TWs broadens eligibility but comes with an increased clinical and imaging screening burden.
Advanced neuroimaging and AI-based decision-support tools help patient selection for these treatments. However, the COVID-19 pandemic has posed additional challenges, highlighting the need for adaptive strategies to maintain effective stroke care.
This research aims to provide insights into the effects of AI-based tools, the impact of COVID-19, and the clinical workload of extended reperfusion therapy time windows, ultimately aiming to improve stroke care and patient outcomes through a multidisciplinary approach.
Our data demonstrated that AI-based decision support can streamline AIS care by facilitating faster decision-making and increasing treatment rates. Extending the EVT time window resulted in a 25% increase in EVT rates and an 83.6% increase in the number of patients screened. The COVID-19 pandemic impacted stroke care, resulting in more severe strokes, longer hospitalization, worse functional outcome and higher mortality rates in the COVID-19 AIS group. Extending both IVT and EVT TWs, using MRI as advanced imaging increased the number of screened patients by 102%. We experienced an 11.7% rise in IVT and a 44% increase in EVT rates, while functional outcomes at 90 days were comparable in the early and late TWs.
Our work highlights the need to stay up-to-date with evolving guidelines and implement them efficiently in clinical practice while continuously evaluating its results at the local level. It is important to assess not only patient outcomes but also the workload and burden associated with it to plan stroke care accordingly. In this era of rapidly advancing stroke care, new trials and research can swiftly impact clinical practices, making it essential to regularly update local guidelines and patient pathways to ensure optimal stroke care.
