Impact of Stroke Team Implementation on Reperfusion Treatment and Workflow Times in Acute Ischemic Stroke: A 13-Year Retrospective Analysis from a Tertiary Center

Background: Timely reperfusion in acute ischemic stroke (AIS) is critical to minimize irreversible brain damage. Intravenous tissue plasminogen activator (IV tPA) and endovascular thrombectomy (EVT) are the current standard treatments. This study aimed to evaluate the impact of stroke team implementation on treatment rates and workflow efficiency in a tertiary hospital. Methods: This retrospective, cross-sectional study included patients diagnosed with AIS and treated with IV tPA and/or EVT between January 2009 and January 2022. Demographic data, treatment-related time metrics, and admission characteristics were recorded. Patients were categorized based on admission time (weekday/weekend, working hours/off-hours) and according to whether they were treated before or after the stroke team was implemented in 2014. Optimal workflow targets were defined according to international guidelines. Statistical analysis was conducted using SPSS v26, with significance set at p<0.05. Results: A total of 396 patients were included (53.8% male). IV tPA was administered to 68.2% and EVT to 31.8% of the patients. After 2014, EVT procedures expanded from limited weekday hours to 24/7 coverage (p=0.006). Significant improvements were observed in door-to-neurologist (p=0.042), door-to-imaging (p=0.013), and door-to-needle (p=0.021) times after stroke team organization. However, door-to-stroke unit transfer time increased (p=0.003). The pandemic period was associated with delays in transfer time (p<0.001). Time metrics were less optimal during off-hours and weekends. Conclusions: The establishment of a dedicated stroke team significantly improved access to EVT and reduced several critical treatment delays. However, challenges remain in optimizing night-shift and inter-hospital referral processes. Stroke systems of care should include regular workflow monitoring and public awareness campaigns to enhance early recognition and access.