Session Report: Optimising pre- and interhospital stroke management

This session on optimising pre- and interhospital stroke management provided a powerful start to ESOC 2026. The presentations highlighted the evolving role of rapid stroke recognition technologies, mobile stroke units, telestroke networks, and simulation-based training, combining scientific insight with practical, system-level applications.

Dr Maren Ranhoff Hov – Oslo University Hospital, Norway

Dr. Maren Ranhoff Hov opened the session with a presentation on emerging technologies for rapid stroke recognition, highlighting the persistent gap between urban and rural stroke care. She emphasized that limited access to specialized centers in rural areas contributes to worse outcomes.

She presented promising solutions, including remotely controlled CT systems, which substantially reduced assessment times and improved access to reperfusion therapies. Mobile Stroke Units were described as a cornerstone of advanced prehospital care.

Looking ahead, she highlighted the potential of lightweight, low-radiation CT technologies, as well as additional tools such as transcranial ultrasound and cerebral oxygenation monitoring in the prehospital setting.

She concluded by underscoring that the true impact of these innovations depends on their effective integration into healthcare systems, supported by training, simulation, and coordinated teamwork.

Professor Guillaume Turc – Sainte-Anne Hospital, Paris, France

Professor Guillaume Turc focused his presentation on the challenges and preliminary results of the ASPHALT randomized control trial, which established the first Mobile Stroke Unit (MSU) program in France.

He detailed the significant administrative obstacles faced in France compared to other European countries. Specifically, the French X-ray protection agency required the MSU to be shielded to the same standards as a stationary hospital room. Furthermore, radiation safety tests were required before the unit could be authorized, yet these tests could not be performed until after the vehicle was fully built.

The Paris MSU operates between 8 a.m. and 6 p.m., targeting suspected stroke patients within a six-hour symptom window. The onboard team is highly specialized, featuring a practitioner trained in both neurology and emergency medicine. Professor Turc reported that the MSU achieved a response time, which was significantly faster than traditional hospital-based care. However, he noted that patient recruitment for the trial was slower than anticipated.

Professor Turc discussed how the trial’s primary outcome was designed as a cost-benefit analysis at the request of French health economists to determine if the system was cost-effective for the French healthcare model.

Dr. Pierre Seners – Hôpital Fondation A. de Rothschild, Paris, France

Dr. Pierre Seners focused his presentation on the development of telestroke networks and the critical challenges associated with inter-hospital transfers. He highlighted that because more than half of stroke patients worldwide require transfer to specialized centers for advanced care, the “door-in-door-out” (DIDO) time is just as vital as in-hospital treatment times.

He advocated for a systematic approach involving all stakeholders to identify bottlenecks and implement data-driven changes. Dr Seners pointed to the success of AI automatic LVO detection software on CT scans, which can significantly reduce the time needed to identify patients requiring urgent transfer.

He highlighted efficient models, where ambulances are dispatched the moment a patient is accepted, and “no-wait” policies that eliminate delays while waiting for transfer decisions. He discussed a model where, instead of transferring the patient, a “flying team” (interventionalist and assistant) is sent to the primary stroke center to perform procedures on-site.

To save critical minutes, he suggested protocols that allow patients to go directly to the angiography suite upon arrival at a comprehensive center, avoiding redundant diagnostic steps.

Dr. Seners concluded by emphasising the importance of team culture, noting that sharing performance data and celebrating successes – such as achieving fast timeliness metrics – is essential for maintaining a highly efficient stroke network.

Professor Silke Walter – Saarland University, Germany

Prof. Silke Walter provided a comprehensive overview of clinical trial evidence in prehospital stroke management, focusing on strategies to accelerate diagnosis and treatment before hospital arrival.

She discussed key trials, including RACECAT, which showed no difference in outcomes between direct transport to comprehensive versus primary stroke centers in suspected LVO, highlighting the complexity of triage decisions. Evidence from MSU trials such as B-PROUD and BEST-MSU demonstrated substantial reductions in treatment times and improved functional outcomes. She also reviewed studies on prehospital thrombolysis, including Tenecteplase versus Alteplase trials, confirming feasibility, and INTERACT-4, which suggested potential benefits of early blood pressure control in selected patients.

She concluded that despite some neutral or heterogeneous trial results, the overarching evidence consistently supports the benefit of faster prehospital identification and treatment, while emphasising the need for continued research and effective implementation in real-world systems.

Professor Waltraud Pfeilschifter – Klinikum Lüneburg, Germany

Professor Waltraud Pfeilschifter focused her presentation on simulation-based training for acute stroke pathways. She argued that while new technologies are vital, the way teams interact and communicate is a subject for specialized training that is now reflected in updated clinical guidelines.

She cited studies indicating that simulation training significantly improves patient outcomes and team interaction. Professor Pfeilschifter shared her personal experience implementing these programs, recommending multidisciplinary teams of five to ten people – including nurses and paramedics – to keep the training manageable and practical.

She noted that simulation training is a key driver in reducing treatment delays and emphasized that even highly experienced teams benefit from regular simulation.