Neighboring Countries, Diverging Protocols: A Comparison of Stroke Pathways from MDRinAIS Study

Abstract Background The MDRinAIS study, funded by the EU under Horizon Europe, aims to develop a telemedicine-based pathway for acute ischemic stroke patients with large vessel occlusion requiring mechanical thrombectomy, to reduce treatment delays and improve outcomes. It compares stroke care protocols across three European networks, analyzing the impact of organizational choices on treatment times and efficiency. Methods The study included retrospective and prospective phases, analyzing ‘drip and ship’ pathways for stroke patients transferred from Primary Stroke Centers (PSCs) to Thrombectomy Capable Centers (TLCs). Data on patient management times and organizational aspects were collected from three countries (Italy, Spain, and Switzerland) to compare pathway efficiency and identify system differences. Results The retrospective phase included 572 patients. Although all patients followed the ‘drip and ship’ approach, treatment pathways differed. The Italian network requires reevaluation and repeat CT at the TLC emergency department, while in Spain repeat CT is needed only if over 60 minutes have passed. Switzerland bypasses the emergency department, directly transferring patients to angiography. These differences led to significant variations in patient management times, such as time between admission to TLC and groin puncture (p < 0.001), with Switzerland showing shorter times, and time from PSC to groin puncture also showing significant differences (p < 0.001), with longer times in Italy. The prospective phase documented protocol changes, including the use of telemedicine to improve communication in Italy and Switzerland, and ER bypass in Italy. Conclusions This study highlights how organizational differences in stroke care pathways affect treatment times and emphasizes the potential of telemedicine to optimize patient management and reduce delays. Key messages • Organizational choices in stroke networks directly impact patient management times. • Redesigning stroke pathways, including telemedicine, may improve efficiency and reduce treatment times.