Recommendations for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities From the Prehospital Stroke System of Care Consensus Conference: A Consensus Statement From the American Academy of Neurology, American Heart Association/American Stroke Association, American Society of Neuroradiology, National Association of EMS Physicians, National Association of State EMS Officials, Society of NeuroInterventional Surgery, and Society of Vascular and Interventional Neurology: Endorsed by the Neurocritical Care Society

Noteworthy advances in the care of patients with acute ischemic stroke (AIS) have occurred in the past 5 years. In 2015, studies of endovascular therapy (EVT) for patients with AIS due to large vessel occlusions (LVOs) demonstrated unequivocal benefit in carefully selected patient populations using stent retriever devices. As a result, in 2015, the American Heart Association (AHA)/American Stroke Association (ASA) released a guideline update reiterating the importance of intravenous (IV) alteplase and recommending "patients should receive EVT with a stent retriever if they meet all the.criteria." However, the benefits of treatment from IV alteplase and EVT are both time sensitive. Thus, the previous AHA/ASA 2005 Recommendations for the Establishment of Stroke Systems of Care required significant revision to ensure timely access to both critical therapies and to reflect the full range of stroke center certifications, including the recently created Joint Commission-approved thrombectomy-capable stroke center (TSC) certification program, intended to serve regions without comprehensive stroke centers to perform EVT. In response to the identified need to develop a set of consensus recommendations for prehospital destination plans tailored to specific population environments, a committee of leading national experts in prehospital acute stroke care was convened at the AHA/ASA International Stroke Conference in January 2018. There was consensus on the need for regional customization of stroke systems of care (SSOCs) to address differences in resources, hospital certifications, geography, and population density and to educate prehospital providers on new models of AIS care, particularly thrombectomy, and how they impact the SSOCs. This article outlines their recommendations and is intended to augment the most recent AHA SSOC policy statement published in 2019.