Recognition and pre-hospital activation: F.A.S.T. (Field Assessment Stroke Triage) for stroke. The earliest stage of acute stroke care is depicted, emphasizing rapid recognition of stroke symptoms in the pre-hospital setting. Facial asymmetry, arm weakness, and speech disturbance are highlighted as key clinical signs prompting activation of emergency medical services. Emergency responder engagement and pre-notification of the receiving hospital are shown as critical steps to reduce time to treatment. The figure establishes the time-sensitive nature of stroke and introduces the vital concept that early recognition initiates the entire cascade of stroke intervention.

Emergency room imaging: diagnosis of stroke. This figure illustrates the role of emergent neuroimaging acquired in the emergency department, including non-contrast computed tomography and vascular imaging to evaluate for ischemia and large vessel occlusion. Exclusion of intracranial hemorrhage is emphasized as a prerequisite for reperfusion therapy. Neuroimaging is presented as a key decision- making checkpoint that determines eligibility for thrombolysis and mechanical thrombectomy, transitioning care from symptom recognition to targeted intervention.

Thrombolysis and early medical therapy: clot busting treatment. Administration of intravenous thrombolytic therapy as an early reperfusion strategy for eligible patients is shown. The figure depicts rapid assessment of inclusion and exclusion criteria, parallel workflow, and minimization of treatment delays. Thrombolysis is presented as a first-line intervention aimed at restoring cerebral blood flow, reinforcing the role of early medical therapy as an initial attempt to re-open a vascular occlusion before escalation to endovascular treatment.

Procedural setup: table preparation. Preparation of the procedural environment for mechanical thrombectomy is shown, including organization of catheters, wires, syringes, stopcocks, and flushing systems on a sterile table. The illustration highlights the importance of readiness and familiarity with equipment prior to vascular access. Proper setup is emphasized as critical to efficiency, safety, and procedural success, marking the transition from diagnostic decision-making to operative intervention.

Bi-plane fluoroscopy: using X-ray. The use of bi-plane fluoroscopy to visualize cerebral vasculature during endovascular stroke treatment is depicted. Real-time X-ray imaging guides catheter and device navigation through the arterial system toward the site of occlusion. The figure emphasizes the role of fluoroscopy in confirming anatomy, device position, and procedural progress during thrombectomy.

Thrombectomy: stent-retriever removal of blood clot. Key steps of mechanical thrombectomy using a stent-retriever device are illustrated. Microcatheter navigation across the occlusion, deployment of the stent-retriever to engage the thrombus, and controlled retrieval under aspiration are shown sequentially. Restoration of blood flow is emphasized as the procedural goal, representing the culmination of endovascular intervention through mechanical clot removal.

Thrombolysis in Cerebral Infarction (TICI) scale: grading success. The TICI grading system used to assess reperfusion following endovascular therapy is presented. Progressive restoration of cerebral blood flow from TICI 0 (no reperfusion) to TICI 3 (complete reperfusion) is visually depicted. The figure demonstrates TICI grading as an objective angiographic measure of procedural success, with higher grades correlating with completeness of revascularization and improved clinical outcomes.

Functional outcomes: rehabilitation of stroke. Post-stroke recovery and rehabilitation following successful reperfusion are shown. Assessment of swallowing and oral intake, improvement in motor function, activities of daily living, and assisted ambulation are illustrated to demonstrate functional recovery over time. This final figure reinforces that stroke intervention extends beyond vessel reopening to meaningful neurologic and functional outcomes, completing the instructional arc by linking acute intervention to patient-centered recovery.