scholarly journals Multimodal CT versus MRI in Selecting Acute Stroke Patients for Endovascular Treatment

2012 ◽  
Vol 1 (2) ◽  
pp. 65-76 ◽  
Author(s):  
Pablo García-Bermejo ◽  
Carlos Castaño ◽  
Antonio Dávalos
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Stroke Patients ◽  
Multimodal Ct

Neuroimaging of Acute Stroke

2017 ◽  
Author(s):  
Chelsea S. Kidwell ◽  
Kambiz Nael
Keyword(s):  
Acute Stroke ◽  
Resonance Imaging ◽  
Significant Progress ◽  
Stroke Patients ◽  
The Past ◽  
Stroke Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Noncontrast Computed Tomography ◽  
Acute Stroke Imaging ◽  
Multimodal Ct

The neuroimaging workup for patients with suspected acute ischemic stroke has advanced significantly over the past few decades. Evaluation is no longer limited to noncontrast computed tomography (CT), but now frequently also includes vascular and perfusion imaging. Although acute stroke imaging has made significant progress with the development of multimodal approaches, there are still many unanswered questions regarding their appropriate use in daily patient care. It is important for all physicians taking care of stroke patients to be familiar with current multimodal CT and magnetic resonance imaging (MRI) techniques, including their strengths, limitations, and their role in guiding therapy.

scholarly journals Percentage of acute stroke patients eligible for endovascular treatment

Neurology ◽  
2012 ◽  
Vol 79 (Issue 13, Supplement 1) ◽  
pp. S22-S25 ◽  
Author(s):  
D. B. Zahuranec ◽  
J. J. Majersik
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Stroke Patients

Abstract 26: RACE to Treat Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Andrea M Korsnack ◽  
Andrea Adams
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Arterial Occlusion ◽  
First Responders ◽  
Artery Occlusion ◽  
Large Vessel ◽  
Stroke Severity ◽  
Large Artery ◽  
Stroke Patients ◽  
Conversion Disorders

Background: Endovascular treatment was shown to drastically improve stroke patient outcomes but earlier identification of eligible patients is crucial. First responders are instrumental to the rapid identification and transportation of stroke patients to the nearest appropriate facility for acute stroke care especially when endovascular intervention is an option. Purpose: To develop and evaluate the effectiveness of an algorithm for first responders to use to differentiate which stroke patients should be transported to the closest Interventional Stroke Center for treatment. Method: We revised the County-Level Emergency Medical Services (EMS) protocol and algorithm to include the Rapid Arterial oCclusion Evaluation (RACE) scale in addition to the Cincinnati Prehospital Stroke Scale (CPPS). Together these simple in-the-field scales assess stroke severity and identify patients with acute stroke and large artery occlusion in a prehospital setting. Lucas County EMS staff received a four hour block of continuing education with credit on acute stroke, the updated protocol and algorithm, and use of the new RACE scale in addition to the CPPS. Effectiveness of the training and use of the RACE alert was measured by the percent of patients accurately identified with and without large artery occlusion. Results: Training was provided to 450 EMS staff in several in-person sessions in June 2015. The RACE protocol went citywide on July first. Of the 18 patients brought in to our hospital by EMS in July using the RACE protocol, 72% were identified correctly using the tool. Of these, 6 were identified correctly as having large vessel occlusions and 7 were correctly identified as not having large vessel occlusions. The remaining 5 patients transported by EMS were identified as large vessel occlusions, but were not found to have strokes (seizures, intoxication, and conversion disorders). Conclusion: Our data suggests that first responders can accurately differentiate between which stroke patients could benefit from endovascular treatment using a simple algorithm. Future evaluation could measure the relationship between accurate pre-hospital identification and treatment rates.

scholarly journals Transfer to the Local Stroke Center versus Direct Transfer to Endovascular Center of Acute Stroke Patients with Suspected Large Vessel Occlusion in the Catalan Territory (RACECAT): Study protocol of a cluster randomized within a cohort trial

2019 ◽  
Vol 14 (7) ◽  
pp. 734-744 ◽  
Author(s):  
Sònia Abilleira ◽  
Natalia Pérez de la Ossa ◽  
Xavier Jiménez ◽  
Pere Cardona ◽  
Dolores Cocho ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Arterial Occlusion ◽  
Large Vessel ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Stroke Center ◽  
Cluster Randomized

Rationale Optimal pre-hospital delivery pathways for acute stroke patients suspected to harbor a large vessel occlusion have not been assessed in randomized trials. Aim To establish whether stroke subjects with rapid arterial occlusion evaluation scale based suspicion of large vessel occlusion evaluated by emergency medical services in the field have higher rates of favorable outcome when transferred directly to an endovascular center (endovascular treatment stroke center), as compared to the standard transfer to the closest local stroke center (local-SC). Design Multicenter, superiority, cluster randomized within a cohort trial with blinded endpoint assessment. Procedure Eligible patients must be 18 or older, have acute stroke symptoms and not have an immediate life threatening condition requiring emergent medical intervention. They must be suspected to have intracranial large vessel occlusion based on a pre-hospital rapid arterial occlusion evaluation scale of ≥5, be located in geographical areas where the default health authority assigned referral stroke center is a non-thrombectomy capable hospital, and estimated arrival at a thrombectomy capable stroke hospital in less than 7 h from time last seen well. Cluster randomization is performed according to a pre-established temporal sequence (temporal cluster design) with three strata: day/night, distance to the endovascular treatment stroke center, and week/week-end day. Study outcome The primary endpoint is the modified Rankin Scale score at 90 days. The primary safety outcome is mortality at 90 days. Analysis The primary endpoint based on the modified intention-to-treat population is the distribution of modified Rankin Scale scores at 90 days analyzed under a sequential triangular design. The maximum sample size is 1754 patients, with two planned interim analyses when 701 (40%) and 1227 patients have completed follow-up. Hypothesized common odds ratio is 1.35.

scholarly journals Angioplasty as an Adjuvant Therapy for the Treatment of Acute Ischemic Stroke

2011 ◽  
Vol 38 (4) ◽  
pp. 593-599 ◽  
Author(s):  
Mohammed Alhazzaa ◽  
Amanda Murphy ◽  
Cheemun Lum ◽  
Marlise P. dos Santos ◽  
Howard Lesiuk ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Intravenous Thrombolysis ◽  
Endovascular Techniques ◽  
Stroke Patients ◽  
Small Cohort ◽  
Symptomatic Intracranial Hemorrhage ◽  
Retrieval Device ◽  
Favorable Functional Outcome ◽  
Arterial Thrombolysis

Abstract:Background:Different endovascular techniques can be employed to achieve vessel recanalization in acute stroke. We assessed whether an endovascular strategy that included angioplasty was safe and effectively recanalized acutely occluded intracranial vessels.Methods:We retrospectively reviewed 70 patients that received intra-arterial therapy for acute stroke. Patients were divided into two groups depending on whether they had received angioplasty as part of their endovascular treatment.Results:Angioplasty was used in the treatment of 35/70 patients (50%). Median baseline NIHSS was 15. The site of occlusion was at the M1 in 11 patients, M1/M2 in 3, ICA/M1 in 13 and vertebrobasilar in 8 patients. Intravenous thrombolysis was administered to 16/35 patients (46%). Angioplasty was used alone in 4 patients, in combination with intra-arterial thrombolysis in 27 and with a mechanical retrieval device or stent in 13 patients. Recanalization (TICI 2-3) was achieved in 23/35 patients (66%). Median time from symptom onset to recanalization was six hours. In patients where angioplasty was employed, symptomatic intracranial hemorrhage occurred in 2/35 (6%), which was similar to patients that were not treated with angioplasty. A favorable functional outcome (mRS=2) was achieved in 20% (7/35) at 24 hour and 34% (12/35) at one month. All patients that had a favorable outcome had recanalized.Conclusion:In this small cohort, an endovascular treatment strategy that employed angioplasty was safe and effectively recanalized acutely occluded intracranial vessels. Angioplasty should be considered as a potential treatment option in interventional acute stroke trials.

Sign in / Sign up

Export Citation Format

Share Document