Every minute counts: WE-TRUST study passes 320-patient milestone in the search for faster stroke care

When a stroke is suspected, every minute matters

To mark World Stroke Day and the WE-TRUST study's 320-patient milestone, Principal Investigators Prof. Raul Nogueira and Dr. Marc Ribó discuss how a faster stroke-care pathway could remove precious minutes from the path to treatment.

Oct 14, 2026 | 4 minute read

When a stroke is suspected, every minute matters

World Stroke Day, marked each year on 29 October, is a reminder of the importance of recognizing stroke symptoms and seeking emergency care without delay. But once a patient reaches hospital, another race against time begins: how quickly can the care team diagnose the stroke, determine the appropriate treatment and restore blood flow to the brain?

For selected patients with an ischemic stroke caused by a large-vessel occlusion, mechanical thrombectomy can remove the blood clot and restore blood flow. Yet in many hospitals, patients first undergo CT or MR imaging in one department before being transferred to the interventional suite for treatment. Each handover and transfer takes time.

The Direct-to-Angio-Suite, or DTAS, pathway is designed to rethink that sequence. Rather than moving a patient from imaging to treatment, it brings triage imaging and potential endovascular treatment together in the angio suite. Cone-beam CT imaging is used to support the care team's assessment, allowing them to decide whether treatment can proceed without an additional transfer.

Philips is sponsoring the global WE-TRUST study to evaluate whether this more streamlined workflow can improve outcomes for appropriately selected stroke patients.

With more than 320 patients enrolled across centres in multiple countries and continents, the study has reached an important milestone in building the evidence needed to understand the pathway's potential at international scale.

From promising idea to international evidence

For Prof. Nogueira, overall Principal Investigator of WE-TRUST, the milestone brings the study closer to answering a question that cannot be resolved in a single hospital: whether a faster stroke pathway can be implemented consistently across different teams and healthcare systems.

"After suffering a stroke, fast time to treatment is paramount to giving patients the best possible outcomes," says Prof. Nogueira. "WE-TRUST gives us the opportunity to assess, across a broad international network, whether a more streamlined pathway can safely remove time from care for eligible patients."

WE-TRUST is a prospective, multicentre, randomised controlled study comparing the DTAS workflow with the conventional CT/MR imaging-first pathway. It is designed to assess whether a faster, in-suite approach can translate into better functional outcomes for eligible patients with acute ischemic stroke caused by a confirmed large-vessel occlusion.

"Reaching 320 patients is important not only because of the number," says Dr. Ribó, overall co-Principal Investigator of WE-TRUST, Interventional Neurologist at Vall d'Hebron University Hospital and researcher at Vall d'Hebron Research Institute in Barcelona, Spain. "Patients are being enrolled across different countries and continents. That shows this is not a workflow limited to a small number of pioneering hospitals; it can be implemented in medium- and high-volume stroke centres around the world."

A faster pathway for the right patients

DTAS is not intended for every patient with suspected stroke. The pathway is designed for patients with a high likelihood of having a Large Vessel Occlusion, and clinical teams must be able to make confident decisions in a fast-moving, high-pressure setting.

"With the help of advanced brain imaging in the angio suite, the aim is to avoid an additional conventional CT or MR triage step for selected patients and save valuable time," says Prof. Nogueira.

That is why image quality is key in this approach.

"High-quality imaging in the angio suite is the essential starting point," says Dr. Ribó. "The team needs to be confident that it can rule out intracranial haemorrhage, assess the patient quickly and make the right decision. If image quality is insufficient, this pathway should not be used."

Modern cone-beam CT capabilities have helped make that confidence possible. Teams also need to become familiar with the acquisition process, including patient positioning and managing motion artefacts. The goal is not simply fast imaging, but imaging reliable enough to support clinical decision-making.

Dr. Ribó (left) and Prof. Nogueira (right)

What it takes to make DTAS work

Introducing a Direct-to-Angio-Suite workflow is not a one-day change.

"There is a learning curve," says Dr. Ribó. "You need coordination among everyone involved in the patient pathway: emergency services, stroke neurologists, interventional teams, nurses, technicians and anaesthesia. You will not achieve excellent door-to-groin times with the first patient."

With practice, clear roles and sufficient case volume, the workflow can become established. In experienced teams, Dr. Ribó says door-to-groin times of around 20 minutes or less can be achievable in many cases, unless an unusual clinical situation requires more time.
Dr. Ribó's advice to centres considering the pathway is deliberately pragmatic: start gradually.

"Choose a moment when the workload is manageable, make sure everyone has discussed the process and understands their role, and begin with an appropriate patient," says Dr. Ribó. "If the experience is positive, repeat it and build from there."

That gradual approach can also have a wider benefit. When teams are prepared to transfer a patient directly to the angio suite and is aware that every minute counts, the conventional emergency workflow can also become faster which benefits these patients too.

The question WE-TRUST is designed to answer

Single-centre studies have suggested that DTAS can reduce time to treatment. But introducing a new clinical pathway more widely requires stronger evidence across different hospitals, teams and healthcare systems.

The study's primary endpoint is patients' functional status 90 days after thrombectomy, measured using the modified Rankin Scale. It also collects workflow measures, including door-to-puncture and door-to-reperfusion times, as well as safety outcomes. Importantly, the trial is designed so that the primary outcome assessment is conducted by trained, blinded assessors.

"Bringing together the experience of stroke centres around the world will help us answer this question rigorously," says Prof. Nogueira. "Can we safely remove time from the pathway for eligible patients, and can that translate into what matters most to them: better recovery and greater independence?"

"We all agree that every minute counts," adds Dr. Ribó. "If we can save 20, 30 or 40 minutes for a patient, the ambition is to show that this can mean less disability, better quality of life and healthier lives after stroke."

With more than 320 patients now enrolled, WE-TRUST is building the international evidence needed to answer that question.

In the video below, the multidisciplinary team at Hôpital Bicêtre in Paris, one of the WE-TRUST investigator sites, shares its experience with the Direct-to-Angio-Suite approach.

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