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REVIEW
Michael S Phipps, Carolyn A Cronin
Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset...
February 13, 2020: BMJ: British Medical Journal
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JOURNAL ARTICLE
Laura K Stein, Stanley Tuhrim, Johanna Fifi, J Mocco, Mandip S Dhamoon
Background and Purpose- Multiple randomized clinical trials have demonstrated the superiority of endovascular therapy (ET) for large vessel occlusion acute ischemic stroke (AIS). Few centers can provide ET, and significant debate exists about the most efficient and effective ways to provide ET. We sought to assess real-world utilization of ET, the extent to which patients are transferred from one hospital to another for therapy and the implications of transfer status on outcomes. Methods- We used the 2015 to 2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database, which contains nationwide data on nearly half of US admissions...
July 2019: Stroke; a Journal of Cerebral Circulation
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JOURNAL ARTICLE
Shreyansh Shah, Ying Xian, Shubin Sheng, Kori S Zachrison, Jeffrey L Saver, Kevin N Sheth, Gregg C Fonarow, Lee H Schwamm, Eric E Smith
BACKGROUND: The use of endovascular therapy (EVT) in patients with acute ischemic stroke who have large vessel occlusion has rapidly increased in the United States following pivotal trials demonstrating its benefit. Information about the contribution of interhospital transfer in improving access to EVT will help organize regional systems of stroke care. METHODS: We analyzed trends of transfer-in EVT from a cohort of 1 863 693 patients with ischemic stroke admitted to 2143 Get With The Guidelines-Stroke participating hospitals between January 2012 and December 2017...
March 26, 2019: Circulation
#4
JOURNAL ARTICLE
Michael T Froehler, Jeffrey L Saver, Osama O Zaidat, Reza Jahan, Mohammad Ali Aziz-Sultan, Richard P Klucznik, Diogo C Haussen, Frank R Hellinger, Dileep R Yavagal, Tom L Yao, David S Liebeskind, Ashutosh P Jadhav, Rishi Gupta, Ameer E Hassan, Coleman O Martin, Hormozd Bozorgchami, Ritesh Kaushal, Raul G Nogueira, Ravi H Gandhi, Eric C Peterson, Shervin R Dashti, Curtis A Given, Brijesh P Mehta, Vivek Deshmukh, Sidney Starkman, Italo Linfante, Scott H McPherson, Peter Kvamme, Thomas J Grobelny, Muhammad S Hussain, Ike Thacker, Nirav Vora, Peng Roc Chen, Stephen J Monteith, Robert D Ecker, Clemens M Schirmer, Eric Sauvageau, Alex Abou-Chebl, Colin P Derdeyn, Lucian Maidan, Aamir Badruddin, Adnan H Siddiqui, Travis M Dumont, Abdulnasser Alhajeri, M Asif Taqi, Khaled Asi, Jeffrey Carpenter, Alan Boulos, Gaurav Jindal, Ajit S Puri, Rohan Chitale, Eric M Deshaies, David H Robinson, David F Kallmes, Blaise W Baxter, Mouhammad A Jumaa, Peter Sunenshine, Aniel Majjhoo, Joey D English, Shuichi Suzuki, Richard D Fessler, Josser E Delgado Almandoz, Jerry C Martin, Nils H Mueller-Kronast
BACKGROUND: Endovascular treatment with mechanical thrombectomy (MT) is beneficial for patients with acute stroke suffering a large-vessel occlusion, although treatment efficacy is highly time-dependent. We hypothesized that interhospital transfer to endovascular-capable centers would result in treatment delays and worse clinical outcomes compared with direct presentation. METHODS: STRATIS (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) was a prospective, multicenter, observational, single-arm study of real-world MT for acute stroke because of anterior-circulation large-vessel occlusion performed at 55 sites over 2 years, including 1000 patients with severe stroke and treated within 8 hours...
December 12, 2017: Circulation
#5
REVIEW
Maxim Mokin, Kenneth V Snyder, Adnan H Siddiqui, Elad I Levy, L Nelson Hopkins
Five recently published randomized trials of endovascular therapy versus medical management, including intravenous thrombolysis, demonstrated strong positive data in support of intra-arterial thrombectomy procedures. The American Heart Association/American Stroke Association released a focused update of the 2013 guidelines on the early management of acute ischemic strokes to specifically incorporate the findings of the 5 "positive" trials. In this review, we examine the key results of those trials and the principal changes in the updated guidelines...
June 7, 2016: Journal of the American College of Cardiology
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