One-Stop manaGemEnT For A Swift initiation of endovascular Therapy (GET-FAST)

• Applicants: Dr. Markus Holtmannspötter; Professor Dr. Jan Liman
• Subject Area: Clinical Neurology; Neurosurgery and Neuroradiology
• Term: since 2025
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 536720425

Stroke is the second leading cause of death and permanent disability. Endovascular treatment (EVT) in addition to intravenous lysis (if the patient is eligible) is the gold standard for the treatment of acute ischemic stroke (AIS) patients due to a large vessel occlusion (LVO). Seven randomized controlled trials demonstrated strong benefits in reducing disability and death, but there is a very strong indication that the beneficial effect of EVT is highly time dependent and declines rapidly with prolonged door to groin (i.e., time between hospital admission and start of EVT) times. In an analysis of 6,756 AIS patients with an LVO. Among every 1,000 patients treated, every 15-minute decrease in door to groin time was associated with 21 more patients discharged home, and 22 more patients having functional independence at discharge. The main problem for the triage of suspected AIS patients is that diagnosis can only be made with brain imaging. The optimized usual care management consisting of a rapid clinical assessment of the patient, diagnostic imaging with multi-detector CT and CT angiography (MDCT and MDCT-A) in the CT room with subsequent transport of EVT eligible patients to the angiography room leads to a door to groin time of approx. 60-70 min. A potential solution to this problem is to conduct both imaging and subsequent EVT in the angiography room using cranial non-contrast flat panel detector CT (FDCT) for the exclusion of an intracranial hemorrhage and FDCT-angiography (FDCT-A) for diagnosis of LVO. A potential problem of One-Stop-Management could be that ot is not calpable of detecting the underlying pathology, which can either be an intracranial bleeding, a small vessel occlusion or a large vessel occlusion. We already showed in a series of 230 patients that such a One-Stop management of suspected AIS patients is feasible and that a substantial reduction of intra-hospital times can be achieved. We therefore aim to evaluate the potential benefits of One-Stop management in severely affected (NIHSS ≥ 10) mothership patients with a suspected AIS in a randomized clinical trial. In the proposed study all CE-certified angiography scanners can be used. If the proposed trial proofs a benefit of One-Stop management in this patient group, it is likely that it will influence future treatment decisions and guidelines. Given the major impact of AIS on morbidity, mortality and quality of life, One-Stop management would have a major impact on the quality of life in a large group of patients.

• DFG Programme: Clinical Trials