WE-TRUST (Workflow Optimization to Reduce Time to Endovascular Reperfusion for Ultra-fast Stroke Treatment)

Inclusion Criteria:

• Subject is 18 years of age or older, or of legal age to give informed consent perstate or national law.

• Baseline NIHSS score obtained prior to randomization must be equal or higher than 10points.

• Subjects with no significant pre-stroke functional disability (modified Rankin scale 0 - 2).

• Subjects suspected of acute ischemic stroke with an estimated arrival time at astroke center (clinical investigational site participating in this study) < 6 hoursfrom symptom onset. Symptom onset is defined as point in time the patient was lastknown well (at baseline).

• Informed consent obtained from patient or his or her legally designatedrepresentative (if locally required).

• Angiography suite immediately available.

• Endovascular treatment team immediately available (Neurologist,Neurointerventionist, Anesthesiologist, Nursing, Technicians as per local standardpractice)

Exclusion Criteria:

Clinical exclusion criteria:

• Known hemorrhagic diathesis, coagulation factor deficiency, or oral anticoagulanttherapy with INR > 3.0

• Known baseline platelet count < 30.000/μL

• Baseline blood glucose of < 50mg/dL (< 2.78mmol/l)

• For patients receiving thrombolysis: severe, sustained hypertension (SBP > 185 mm Hgor DBP > 110 mm Hg). Note: If the blood pressure can be successfully reduced andmaintained at the acceptable level using AHA/ASA guidelines recommended medication (including IV antihypertensive drips), the patient can be enrolled.

• Patients from a transfer center (Primary Stroke Center) with a CT/MR that is notrequired to be redone in the Comprehensive Stroke Center as per discretion of thephysician or per local standards (e.g. CT/MR less then 90 minutes old).

• Patients in coma (NIHSS item of consciousness >1) defined as totally unresponsive;responding only with reflexes or being areflexic (Intubated patients for transfercould be randomized only in case an NIHSS is obtained by a neurologist priortransportation).

• Patients with extreme vomiting

• Patients that are extremely agitated

• Seizures at stroke onset which would preclude obtaining a baseline NIHSS

• Serious, advanced, or terminal illness with anticipated life expectancy of less thanone year.

• Patients acquired stroke while in-hospital

• History of life threatening allergy (more than rash) to contrast medium

• Cerebral vasculitis

• Patients with a pre-existing neurological or psychiatric disease that would confoundthe neurological or functional evaluations, mRS score at baseline must be ≤2. Thisexcludes patients who are severely demented, require constant assistance in anursing home type setting or who live at home but are not fully independent inactivities of daily living (toileting, dressing, eating, cooking and preparingmeals, etc.)

• Unlikely to be available for 90-day follow-up (e.g. no fixed home address, visitorfrom overseas).

• Patients with unstable clinical status who require emergent life support care

• Any condition that, in the judgment of the investigator could impose hazards to thepatient if study therapy is initiated or affect the participation of the patient inthe study.

• Subject participates in a potentially confounding drug or device trial during thecourse of the study.

• Woman of childbearing potential who is known to be pregnant on admission.

• Subject meets an exclusion criteria according to national law (e.g. age, pregnantwoman, breast feeding woman)

• Subject is Philips employee or their family members residing with this Philipsemployee.