{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T09:37:55Z","timestamp":1786441075298,"version":"build-2736575974"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["JR22\/00046"],"award-info":[{"award-number":["JR22\/00046"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["CM23\/00280"],"award-info":[{"award-number":["CM23\/00280"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Timely transfer of patients with suspected LVO remains critical in acute stroke systems. Artificial intelligence (AI)-based imaging tools are increasingly implemented to support triage in non-thrombectomy centres. We assessed whether integrating an AI algorithm within established tele-stroke centres reduces time to transfer decision.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We conducted a prospective, multicentre, quasi-experimental study comparing consecutive cohorts in 2 tele-stroke centres referring to a single comprehensive stroke centre, before and after implementation of the Methinks Stroke Suite, an AI algorithm for LVO detection on non-contrast CT (NCCT) and CTA. Consecutive transferred patients with suspected acute ischaemic stroke were included. Remote vascular neurologists retained responsibility for final transfer decisions. Each phase spanned approximately 15\u00a0months. The primary outcome was time from arrival at the local centre to emergency medical services activation. Secondary outcomes included workflow intervals, imaging utilisation and algorithm performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 265 patients (136 in the post-implementation cohort; 129 in the pre-implementation cohort). Adjusted median time from arrival to transfer request did not differ (median difference\u00a0\u2212\u00a02.40\u00a0min; 95% CI, \u22126.16 to 4.48). Post-implementation, time from imaging to transfer request (\u22127.16\u00a0min; 95% CI, \u221213.02 to \u22121.85) and arrival to groin puncture (\u221231.28\u00a0min; 95% CI, \u221260.89 to \u221213.74) decreased. Computed tomography angiography acquisition at referring centres increased (28%\u201381%), reducing repeat imaging at the comprehensive centre (79%\u201342%). Non-contrast CT-based AI prediction yielded a positive predictive value of 66% for endovascular treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Artificial intelligence implementation was not associated with a shorter time to transfer decision. Fewer redundant imaging examinations were associated with a shorter time to reperfusion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag085","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T17:00:12Z","timestamp":1784912412000},"source":"Crossref","is-referenced-by-count":0,"title":["CATalyze-AI: accelerating referral for thrombectomy in acute stroke patients using an AI-based software. A prospective, multicentre, quasi-experimental cohort study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4637-1598","authenticated-orcid":false,"given":"Marta","family":"Olive-Gadea","sequence":"first","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]},{"name":"Departament de Medicina, Universitat Aut\u00f2noma de Barcelona , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Cocho","sequence":"additional","affiliation":[{"name":"Neurology Department, Hospital General de Granollers , Granollers ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judit Roca","family":"Font","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitari de Vic , Vic ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Rodrigo-Gisbert","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]},{"name":"Interventional Neuroradiology, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Muchada","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8100-9477","authenticated-orcid":false,"given":"Marta Rubiera","family":"del Fueyo","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8053-4536","authenticated-orcid":false,"given":"David","family":"Rodriguez-Luna","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renato","family":"Simonetti","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noelia","family":"Rodriguez-Villatoro","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge","family":"Pagola","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Artur","family":"Izquierdo","sequence":"additional","affiliation":[{"name":"Neurology Department, Hospital General de Granollers , Granollers ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gemma","family":"Planells","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital General de Granollers , Granollers ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jose","family":"Cortes","sequence":"additional","affiliation":[{"name":"Radiology Department, Hospital Universitari de Vic , Vic ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria \u00c0ngels","family":"Font","sequence":"additional","affiliation":[{"name":"Neurology Department, Hospital Universitari de Vic , Vic ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoletta","family":"Brunelli","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriano","family":"Bonura","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Requena","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]},{"name":"Emergency Department, Hospital Universitari de Vic , Vic ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordi","family":"Mayol","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ane","family":"Murillo","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"Jord\u00e0-Baleri","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Cendrero","sequence":"additional","affiliation":[{"name":"Grup de Recerca en Ictus, Vall d\u2019Hebron Institut de Recerca , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Tomasello","sequence":"additional","affiliation":[{"name":"Emergency Department, Hospital Universitari de Vic , Vic ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Molina","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xabi","family":"Urra","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Clinic , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Garcia-Tornel","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[{"name":"Stroke Unit, Neurology Department, Hospital Universitari Vall d\u2019Hebron , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"2026081105070454800_ref1","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1016\/S1474-4422(20)30102-2","article-title":"Prehospital stroke management in the thrombectomy era","volume":"19","author":"Fassbender","year":"2020","journal-title":"Lancet Neurol"},{"key":"2026081105070454800_ref2","doi-asserted-by":"publisher","first-page":"1782","DOI":"10.1001\/jama.2022.4404","article-title":"Effect of direct transportation to thrombectomy-capable center vs local stroke center on neurological outcomes in patients with suspected large-vessel occlusion stroke in nonurban areas: the RACECAT randomized clinical trial","volume":"327","author":"P\u00e9rez de la Ossa","year":"2022","journal-title":"JAMA"},{"key":"2026081105070454800_ref3","doi-asserted-by":"publisher","first-page":"e2534275","DOI":"10.1001\/jamanetworkopen.2025.34275","article-title":"Telestroke and timely treatment and outcomes in patients with acute ischemic stroke","volume":"8","author":"Stamm","year":"2025","journal-title":"JAMA Netw Open"},{"key":"2026081105070454800_ref4","doi-asserted-by":"publisher","DOI":"10.1161\/SVIN.123.001213","article-title":"Evaluating transport strategies and local hospital impact on stroke outcomes: a RACECAT trial substudy","volume":"4","author":"Olive-Gadea","year":"2024","journal-title":"Stroke Vasc Interv Neurol"},{"key":"2026081105070454800_ref5","volume-title":"Mem\u00f2ria d\u2019activitat: Regi\u00f3 Sanit\u00e0ria Barcelona 2007","author":"CatSalut"},{"key":"2026081105070454800_ref6","doi-asserted-by":"publisher","first-page":"3133","DOI":"10.1161\/STROKEAHA.120.030326","article-title":"Deep learning based software to identify large vessel occlusion on noncontrast computed tomography","volume":"51","author":"Olive-Gadea","year":"2020","journal-title":"Stroke"},{"key":"2026081105070454800_ref7"},{"key":"2026081105070454800_ref8","author":"Ag\u00e8ncia de Qualitat i Avaluaci\u00f3 Sanit\u00e0ries de Catalunya"},{"key":"2026081105070454800_ref9","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1136\/jnis-2023-020125","article-title":"Influence of vascular imaging acquisition at local stroke centers on workflows in the drip-n-ship model: a RACECAT post hoc analysis","volume":"16","author":"Flores","year":"2024","journal-title":"J Neurointerv Surg"},{"key":"2026081105070454800_ref10","doi-asserted-by":"publisher","first-page":"631","DOI":"10.1177\/15910199221122848","article-title":"The implementation of artificial intelligence significantly reduces door-in-door-out times in a primary care center prior to transfer","volume":"29","author":"Hassan","year":"2023","journal-title":"Interv Neuroradiol"},{"key":"2026081105070454800_ref11","doi-asserted-by":"publisher","first-page":"1329643","DOI":"10.3389\/fneur.2023.1329643","article-title":"Artificial intelligence-based decision support software to improve the efficacy of acute stroke pathway in the NHS: an observational study","volume":"14","author":"Nagaratnam","year":"2024","journal-title":"Front Neurol"},{"key":"2026081105070454800_ref12","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1001\/jamaneurol.2023.3206","article-title":"Automated large vessel occlusion detection software and thrombectomy treatment times: a cluster randomized clinical trial","volume":"80","author":"Martinez-Gutierrez","year":"2023","journal-title":"JAMA Neurol"},{"key":"2026081105070454800_ref13","doi-asserted-by":"publisher","first-page":"e001306","DOI":"10.1161\/SVIN.123.001306","article-title":"Door to puncture in large vessel occlusions pre- and postimplementation of an automated image interpretation and communication platform: a single center study","volume":"4","author":"Frost","year":"2024","journal-title":"Stroke Vasc Interv Neurol"},{"key":"2026081105070454800_ref14","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2025-023872","article-title":"Integrated drip-and-ship improves stroke transfer efficiency and outcomes: a comparison with traditional drip-and-ship and mothership models","volume":"18","author":"Wang","journal-title":"J Neurointerv Surg"},{"key":"2026081105070454800_ref15","doi-asserted-by":"publisher","first-page":"100927","DOI":"10.1016\/j.landig.2025.100927","article-title":"Artificial intelligence imaging decision support for acute stroke treatment in England: a prospective observational study","volume":"7","author":"Nagaratnam","year":"2025","journal-title":"Lancet Digit Health"},{"key":"2026081105070454800_ref16","doi-asserted-by":"publisher","first-page":"e33540","DOI":"10.2196\/33540","article-title":"How clinicians perceive artificial intelligence-assisted technologies in diagnostic decision making: mixed methods approach","volume":"23","author":"Hah","year":"2021","journal-title":"J Med Internet Res"},{"key":"2026081105070454800_ref17","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1038\/s41467-024-55259-x","article-title":"Intricacies of human-AI interaction in dynamic decision-making for precision oncology","volume":"16","author":"Niraula","year":"2025","journal-title":"Nat Commun"},{"key":"2026081105070454800_ref18","doi-asserted-by":"publisher","first-page":"e136","DOI":"10.1016\/S2589-7500(24)00250-4","article-title":"Diagnoses supported by a computerised diagnostic decision support system versus conventional diagnoses in emergency patients (DDX-BRO): a multicentre, multiple-period, double-blind, cluster-randomised, crossover superiority trial","volume":"7","author":"Hautz","year":"2025","journal-title":"Lancet Digit Health"},{"key":"2026081105070454800_ref19","doi-asserted-by":"publisher","first-page":"e175","DOI":"10.1016\/S2589-7500(24)00267-X","article-title":"Screening performance and characteristics of breast cancer detected in the Mammography Screening with Artificial Intelligence trial (MASAI): a randomised, controlled, parallel-group, non-inferiority, single-blinded, screening accuracy study","volume":"7","author":"Hernstr\u00f6m","year":"2025","journal-title":"Lancet Digit Health"},{"key":"2026081105070454800_ref20","doi-asserted-by":"publisher","DOI":"10.1136\/jnis-2025-023775","article-title":"Impact of pre-test probability on AI-LVO detection: a systematic review of LVO prevalence across clinical contexts","author":"Oliv\u00e9-Gadea","journal-title":"J Neurointerv Surg"},{"key":"2026081105070454800_ref21","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.1097\/00005650-200411000-00010","article-title":"Using Medicare data to estimate the number of cases missed by a cancer registry: a 3-source capture-recapture model","volume":"42","author":"McClish","year":"2004","journal-title":"Med Care"},{"key":"2026081105070454800_ref22","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1161\/CIRCOUTCOMES.108.844399","article-title":"Patient registries of acute coronary syndrome: assessing or biasing the clinical real world data?","volume":"2","author":"Ferreira-Gonz\u00e1lez","year":"2009","journal-title":"Circ Cardiovasc Qual Outcomes"},{"key":"2026081105070454800_ref23","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.jclinepi.2008.04.007","article-title":"Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis","volume":"62","author":"Leeflang","year":"2009","journal-title":"J Clin Epidemiol"},{"key":"2026081105070454800_ref24","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1148\/radiol.220182","article-title":"Methods for clinical evaluation of artificial intelligence algorithms for medical diagnosis","volume":"306","author":"Park","year":"2023","journal-title":"Radiology"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/11\/7\/aakag085\/69960654\/aakag085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/11\/7\/aakag085\/69960654\/aakag085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T09:13:42Z","timestamp":1786439622000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/doi\/10.1093\/esj\/aakag085\/8741547"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":24,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7,6]]}},"URL":"https:\/\/doi.org\/10.1093\/esj\/aakag085","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,7]]},"published":{"date-parts":[[2026,7]]},"article-number":"aakag085"}}