Abstract 11: Comparison Of Various Methods Of Assessment Of Intracranial Collaterals On The Pretreatment Ct-angiograms To Predict Outcomes In Acute Anterior Circulation Ischemic Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
leonard L yeo ◽  
benjamin wakerley ◽  
Aftab Ahmad ◽  
prakash Paliwal ◽  
kay ng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Treatment Time ◽  
Scoring Systems ◽  
Anterior Circulation ◽  
Unaffected Side ◽  
Computed Tomographic ◽  
Pre Treatment ◽  
Iv Tpa

Background: The presence of effective collateral blood flow patterns may influence response to intravenously administered tissue plasminogen activator (IV-tPA) in acute ischemic stroke (AIS). We compared various existing methods of scoring collaterals on the pre-treatment computed tomographic angiogram (CTA) of the brain for a reliable prediction of functional outcome in AIS patients. Methods: Consecutive AIS patients treated with IV-tPA within 4.5 hours of symptom-onset during 2007-2011 were included. Data were collected for demographics, vascular risk factors, National Institute of Health Stroke Scale (NIHSS) scores and stroke subtypes. Intracranial collaterals were evaluated by 2 independent blinded neuroradiologists via 4 predefined criteria- Miteff’s system that grades middle cerebral artery (MCA) collateral branches with respect to the sylvian fissure; Maas system that compares collaterals on the affected hemisphere against the unaffected side; modified Tan’s scale where collaterals in 50% or more of the MCA territory are classified as good; and a 20-point collateral grading scale in regions corresponding to Alberta Stroke Program Early CT score (ASPECTS) methodology. Good functional outcomes at 3-months were determined by modified Rankin scale (mRS) scores of 0-1. Results: CTA was performed in 115 patients with anterior circulation AIS before IV-tPA bolus. Median age 66yrs (range 35-92), 42% males, median NIHSS 19 points (range 3-30) and median onset-to-treatment time 155 minutes. Overall, 52 (45.2%) patients achieved good functional outcome at 3-months. Univariable analysis revealed younger age, absence of diabetes, lower pre-tPA NIHSS scores and good collaterals according to ASPECTS methodology as significantly associated with good functional outcomes. On multivariable logistic regression, only lower NIHSS (OR 1.111 per NIHSS point; 95% CI 1.023-1.206, p=0.013) and good collaterals by ASPECTS methodology (OR 1.117 per point; 95%CI 1.006-1.241, p=0.039) were found as independent predictors of good outcomes. Conclusion: Of the existing intracranial collaterals scoring systems, only the ASPECTS methodology serves as a reliable predictor of favorable outcomes at 3-months in patients with anterior circulation AIS.

Abstract 3275: Early Neurological Improvement After Intravenous Thrombolysis in Acute Stroke Predicts Long-Term Functional Outcome

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Leonard L Yeo ◽  
Liang Shen ◽  
Ben Wakerley ◽  
Aftab Ahmad ◽  
Kay W Ng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Symptom Onset ◽  
Functional Outcomes ◽  
Treatment Time ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Neurological Improvement ◽  
Iv Tpa

Background: Intravenously administered tissue plasminogen activator (IV-TPA) remains the only approved therapeutic agent for arterial recanalization in acute ischemic stroke (AIS). Wide variations in the rates and timing of neurological recovery are observed in thrombolyzed patients. While all IV-TPA treated patients are routinely evaluated for neurological recovery at 24-hours, considerable improvement occurs in some cases within 2-hours of treatment initiation. We evaluated whether early neurological improvement at 2-hours after IV-TPA bolus (ENI-2) can predict functional outcomes in thrombolyzed AIS patients at 3-months. Methods: Data for consecutive stroke patients treated with IV-TPA within 4.5 hours of symptom-onset during 2007-2010 were prospectively entered in the thrombolyzed registry maintained at our tertiary care center. Data were collected for demographic characteristics, vascular risk factors, stroke subtypes and blood pressure levels before IV-TPA bolus. National Institute of Health Stroke Scale (NIHSS) scores were obtained before IV-TPA bolus and at 2-hours. ENI-2 was defined as a reduction in NIHSS score by more than 10-points from baseline score or an absolute score of 4-points or less at 2-hours after IV-TPA bolus. Functional outcomes at 3-months were determined by modified Rankin scale (mRS). Data were analyzed by SPSS 19.0. Results: Of the 2238 AIS patients admitted during the study period, 240 (11%) received IV-TPA within 4.5-hours of symptom-onset. Median age was 65yrs (range 19-92), 63% males, median NIHSS 17points (range 3-35) and median onset-to-treatment time 149 minutes. Overall, 122 (50.8%) patients achieved favorable functional outcome (mRS 0-1) at 3-months. Factors associated with favorable outcome at 3-months on univariable analysis were younger age, female gender, presence of atrial fibrillation, baseline NIHSS, onset-to-treatment time (OTT) and ENI-2. However, multivariable analysis demonstrated NIHSS at onset (OR per 1-point increase 0.907, 95%CI 0.848-0.969) and ENI-2 (OR 4.926 95%CI 1.66-15.15) as independent predictors of favorable outcome at 3-months. Conclusion: Early Neurological improvement at 2-hours after IV-TPA bolus is a strong predictor of the functional outcome at 3-months in acute ischemic stroke patients.

scholarly journals Posterior communicating and anterior communicating arteries on pre-thrombectomy computed tomography scans are associated with good outcomes irrespective of leptomeningeal collateral status

2019 ◽  
Vol 25 (4) ◽  
pp. 364-370 ◽  
Author(s):  
Leonard LL Yeo ◽  
Tommy Andersson ◽  
Åke Holmberg ◽  
Anastasios Mpotsaris ◽  
Michael Söderman ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Functional Outcomes ◽  
Scoring Systems ◽  
Computed Tomographic Angiography ◽  
National Institutes Of Health ◽  
Anterior Communicating Artery ◽  
Collateral Flow ◽  
Anterior Circulation ◽  
Computed Tomographic ◽  
Pre Treatment

Background Collateral blood flow is known to be an important factor that sustains the penumbra during acute stroke. We looked at both the leptomeningeal collateral circulation and the presence of anterior and posterior communicating arteries to determine the factors associated with good outcomes and mortality. Methods We included all patients with acute ischaemic stroke in the anterior circulation, who underwent thrombectomy with the same thrombectomy device from 2013 to 2016. We assessed the leptomeningeal circulation by the Tan, Miteff and Maas validated scoring systems on pre-treatment computed tomographic angiography scans and looked at collateral flow through anterior and posterior communicating arteries. The results were good functional outcomes at 3 months (modified Rankin scale 0–2) and mortality. Results A total of 147 consecutive acute stroke patients treated with the Embotrap device were included with a median National Institutes of Health stroke scale of 15 (range 2–26). On multivariate analysis only younger age (odds ratio (OR) 0.96/year, 95% confidence interval (CI) 0.94–0.99, P = 0.026), lower National Institutes of Health stroke scale score (OR 0.87/point, 95% CI 0.80–0.93, P < 0.001), number of attempts (OR 0.80/attempt, 95% CI 0.65–0.99, P = 0.043) and the presence of a patent anterior communicating artery (OR 14.03, 95% CI 1.42–139.07, P = 0.024) were associated with good functional outcomes. The number of attempts (OR 1.66/attempt, 95% CI 1.21–2.29, P = 0.002) was significantly associated with mortality and the presence of a patent posterior communicating artery (OR 0.098, 95% CI 0.016–0.59, P = 0.011) was inversely associated with mortality. Conclusions Our study shows that the presence of anterior and posterior communicating arteries is significantly associated with good functional outcomes and reduced mortality, respectively, independent of the leptomeningeal circulation status.

Abstract T P39: Serial Alberta Stroke Program Early Ct Score (aspects) Is A Superior Predictor Of Outcomes With Iv Rtpa

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Leonard Yeo ◽  
Prakash Paliwal ◽  
Hockluen Teoh ◽  
Bernard Chan ◽  
Raymond Seet ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Ischemic Stroke ◽  
Ct Scan ◽  
Functional Outcomes ◽  
Roc Curves ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Serial Change ◽  
Pre Treatment ◽  
Iv Tpa

Background and purpose: The Alberta stroke program early computed tomography score (ASPECTS) on baseline imaging is known predictor of outcomes for acute ischemic stroke (AIS) patients. We looked at the change in ASPECTS at the baseline CT and 24hr CT in AIS patients treated with IV rTPA to determine if it can help predict 3 month functional outcomes. Methods: Consecutive AIS patients receiving IV-tPA within 4.5 hours of symptom-onset during 2010-2013 and underwent pre-treatment and day-2 CT were included ASPECTS at the baseline CT and 24hr CT were independently scored in all anterior circulation stroke patients who underwent IV rTPA within 4.5 hours of onset. ASPECTS at baseline, 24hrs and the serial change were analyzed. Results: 210 consecutive AIS patients were included. ROC curves for ASPECTS on the initial CT scan for MRS 0-1 was AUC 0.613, 95% CI 0.536-0.690, p=0.005, while ROC curves for ASPECTS on the 24hr CT scan for MRS0-1 was AUC 0.763 95% CI 0.699 - 0.828, p <0.001. ASPECTS on the 24hr CT was statistically significantly better able to predict outcomes compared to the initial CT (z= -2.936, p = 0.001). 28 out of 210 patients had an increase in ASPECTS by >3 with a 3-fold risk of worse outcomes (OR 3.572 95%CI 1.393- 9.156, p=0.08). Conclusion: ASPECT scores on 24hr CT have better prognostic ability compared to the baseline scan. Serial ASPECT scores are a viable surrogate predictor in AIS patients treated with IV rTPA.

scholarly journals Intracranial Hemorrhage After Reperfusion Therapies in Acute Ischemic Stroke Patients

2020 ◽  
Vol 11 ◽  
Author(s):  
Benjamin Maïer ◽  
Jean Philippe Desilles ◽  
Mikael Mazighi
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Tissue Type ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Early Reperfusion ◽  
Iv Tpa

Reperfusion therapies are the mainstay of acute ischemic stroke (AIS) treatments and overall improve functional outcome. Among the established complications of intravenous (IV) tissue-type plasminogen activator (tPA), intracranial hemorrhage (ICH) is by far the most feared and has been extensively described by seminal works over the last two decades. Indeed, IV tPA is associated with increased odds of any ICH and symptomatic ICH responsible for increased mortality rate during the first week after an AIS. Despite these results, IV tPA has been found beneficial in several pioneering randomized trials and improves functional outcome at 3 months. Endovascular therapy (EVT) combined with IV tPA for AIS patients consecutive to an anterior circulation large-vessel occlusion does not increase ICH occurrence. Of note, EVT following IV tPA leads to significantly higher rates of early reperfusion than with IV tPA alone, with no difference in ICH, which challenges the paradigm of reperfusion as a major prognostic factor for ICH complications. However, several blood biomarkers (glycemia, platelet and neutrophil count), clinical factors (age, AIS severity, blood pressure management, diabetes mellitus), and neuroradiological factors (cerebral microbleeds, infarct size) have been identified as risk factors for ICH after reperfusion therapy. In the years to come, the ultimate goal will be to further improve either reperfusion rates and functional outcome, while reducing hemorrhagic complications. To this end, various approaches being investigated are discussed in this review, such as blood-pressure control after reperfusion or the use of new antiplatelet agents as an adjunct to IV tPA and exhibit reduced hemorrhagic potential during the early phase of AIS.

scholarly journals Collateral estimation by susceptibility-weighted imaging and prediction of functional outcomes after acute anterior circulation ischemic stroke

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hyung Jin Lee ◽  
Hong Gee Roh ◽  
Sang Bong Lee ◽  
Yoo Sung Jeon ◽  
Jeong Jin Park ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Susceptibility Weighted Imaging ◽  
Lesion Volume ◽  
Anterior Circulation ◽  
Nihss Score ◽  
Sex Risk ◽  
Lower Baseline ◽  
Younger Age

AbstractTo determine the value of susceptibility-weighted imaging (SWI) for collateral estimation and for predicting functional outcomes after acute ischemic stroke. To identify independent predictors of favorable functional outcomes, age, sex, risk factors, baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline diffusion-weighted imaging (DWI) lesion volume, site of steno-occlusion, SWI collateral grade, mode of treatment, and successful reperfusion were evaluated by multiple logistic regression analyses. A total of 152 participants were evaluated. A younger age (adjusted odds ratio (aOR), 0.42; 95% confidence interval (CI) 0.34 to 0.77; P < 0.001), a lower baseline NIHSS score (aOR 0.90; 95% CI 0.82 to 0.98; P = 0.02), a smaller baseline DWI lesion volume (aOR 0.83; 95% CI 0.73 to 0.96; P = 0.01), an intermediate collateral grade (aOR 9.49; 95% CI 1.36 to 66.38; P = 0.02), a good collateral grade (aOR 6.22; 95% CI 1.16 to 33.24; P = 0.03), and successful reperfusion (aOR 5.84; 95% CI 2.08 to 16.42; P = 0.001) were independently associated with a favorable functional outcome. There was a linear association between the SWI collateral grades and functional outcome (P = 0.008). Collateral estimation using the prominent vessel sign on SWI is clinically reliable, as it has prognostic value.

Abstract W P35: Assessment of Collaterals on Day-2 CT Angiography Can Predict Functional Outcome in Thrombolyzed Anterior Circulation Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
leonard L yeo ◽  
Prakash Paliwal ◽  
Hock Luen Teoh ◽  
Raymond C Seet ◽  
Bernard P Chan ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Ct Angiography ◽  
Treatment Time ◽  
Multivariable Analysis ◽  
Favourable Outcome ◽  
Anterior Circulation ◽  
Good Functional Outcome ◽  
Intravenous Tissue Plasminogen Activator ◽  
Younger Age ◽  
Iv Tpa

Background: Several methods exist that assess the intracranial collaterals on CT-angiography (CTA) of the brain. We compared existing methods for quantification of collaterals on day-2 CTA in thrombolyzed AIS patients to assess their predictive value for functional outcome. Methods: Consecutive AIS patients treated with intravenous tissue plasminogen activator (IV-tPA) during 2007-2012 were included. Data were collected for demographics, vascular risk factors, NIHSS scores and stroke subtypes. Intracranial collaterals were evaluated by 2 independent neuroradiologists using 4 existing methods- Miteff’s system (grades middle cerebral artery (MCA) collateral branches with respect to sylvian fissure); Maas system (compares collaterals in affected hemisphere against the contralateral side); Modified Tan’s scale (collaterals in 50% or more of MCA territory classified as good); and 20-point collateral grading scale by Alberta Stroke Program Early CT score (ASPECTS) methodology. Good functional outcome at 3-months was determined by modified Rankin scale (mRS) scores of 0-1. Results: Day-2 CTA was performed in 150 patients with anterior circulation AIS treated with IV-tPA. Median age 66yrs (range 33-92), 47% males, median NIHSS 19 points (range 4-34) and median onset-to-treatment time 165 minutes (range 74-274). Overall, 67 (44.6%) patients achieved good functional outcome at 3-months. On univariable analysis- younger age, lower pre-tPA NIHSS scores, atrial fibrillation, good collaterals according to ASPECTS scoring and good collaterals by Maas methodology were significantly associated with good functional outcome. On multivariable analysis, lower NIHSS (OR 1.155 per NIHSS point; 95% CI 1.066-1.251, p=0.001), younger age (OR 1.052 per year; 95% CI 1.012-1.094, p=0.010), good collaterals by Maas methodology (OR 2.805 95% CI 1.122 -7.011, p =0.002) and good collaterals (score of 9 or more) by ASPECTS methodology (OR 3.769 ; 95%CI: 1.327- 10.708, p= 0.013 ) were found as independent predictors of good outcome. Conclusion: Of the existing intracranial collaterals scoring systems, only the ASPECTS and Maas methods are reliable predictor of favourable outcome in thrombolyzed anterior circulation AIS patients.

Abstract P471: Ipsilateral Asymmetrical Internal Cerebral Vein on Multiphasic Computed Tomography for Acute Anterior Circulation Ischemic Stroke Thrombectomy is an Independent Predictor of Poor Functional Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
May Zin Myint ◽  
Benjamin Yong Qiang Tan ◽  
Aloysius Sheng Ting Leow ◽  
Ei Zune The ◽  
Cunli Yang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Multivariate Analysis ◽  
Ischemic Stroke ◽  
Functional Outcome ◽  
Intracranial Hemorrhage ◽  
Functional Outcomes ◽  
Collateral Circulation ◽  
Poor Functional Outcome ◽  
Anterior Circulation ◽  
Symptomatic Intracranial Hemorrhage

Background: National Institute of health stroke scale(NIHSS) and collateral circulation are well-established predictors for functional outcomes of endovascular thrombectomy (EVT) patients in acute ischemic stroke (AIS), nonetheless additional prognostic markers can improve the prediction of stroke outcomes. The inflow and drainage into the internal cerebral veins (ICV) can be seen consistently on multiphasic computed tomography angiography (mCTA). Thus, we hypothesize that asymmetry of ICV in the mCTA in large vessel occlusion AIS can be used as an adjunctive predictor of functional outcomes and complications. Method: We enrolled 185 consecutive anterior circulation AIS patients who underwent EVT that presented to our hospital between 2017 and 2019. The collateral circulation was defined by the university of Calgary mCTA collateral flow assessment in stroke. The ICV on the ipsilateral occlusion side was compared with the contralateral side according to a binary scale: 1 (less than contralateral or absent) or 2(equal or greater than contralateral). The primary outcome was modified Rankin scale at 3 months (mRS), and secondary outcomes included symptomatic intracranial hemorrhage and mortality. Result: Among 185 patients, 53% were men, the median age 70 years (range 29-91) and the median NIHSS score on arrival (NIHSS OA) was 19 (range 4-34). 82 patients (44.3%) had good functional outcomes at 3 months. Ipsilateral asymmetry in all three stages of mCTA were statistically significantly associated with good functional outcomes. The 1 st delay phase of mCTA showed the strongest association. On multivariate analysis, high NIHSS OA (OR 1.09, 95% CI 1.02-1.15, P = 0.007), good mCTA collateral score (OR 0.30, 95% CI .16- .53, P < .001), ipsilateral asymmetrical ICV on the 1 st delay phase of mCTA (OR 2.64, 95% CI 1.17-5.96, P = 0.01) were independent predictors of poor functional outcome. Ipsilateral asymmetry was not associated with mortality or symptomatic intracranial hemorrhage on multivariate analysis. Conclusion: Ipsilateral assymetrical ICV is a novel radiological marker associated with functional outcomes after thrombectomy even after correction for the collateral circulation. Further studies should be done to validate this finding in different datasets.

Abstract 3290: Timing Of Recanalization After Intravenous Thrombolysis Determines The Functional Outcomes In Acute Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Leonard L Yeo ◽  
Ben Wakerley ◽  
Liang Shen ◽  
Prakash R Paliwal ◽  
Aftab Ahmad ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Functional Outcomes ◽  
Treatment Time ◽  
Tertiary Care ◽  
Favorable Outcome ◽  
Arterial Recanalization ◽  
Arterial Patency ◽  
Iv Tpa

Background and Purpose: Intravenously administered tissue plasminogen activator (IV-TPA) is the only approved therapeutic agent for arterial recanalization in acute ischemic stroke (AIS). Wide variations in rates and timing of neurological recovery are observed in thrombolyzed patients. Although, recanalization of acutely occluded intracranial artery remains the major aim IV-TPA, timing and impact of this phenomenon on functional outcomes has not been evaluated properly. We evaluated the relationship between the arterial patency and timing of recanalization with functional outcomes at 3-months in AIS. Methods: Data for consecutive AIS patients treated with IV-TPA within 4.5 hours of symptom-onset during 2007-2010 were prospectively entered in the thrombolysis registry maintained at our tertiary care center. Data were collected for demographic characteristics, vascular risk factors, stroke subtypes and blood pressure before IV-TPA bolus. National Institute of Health Stroke Scale (NIHSS) scores were obtained before IV-TPA, at 2-hours and at 24-hours. Patients were continuously monitored with 2-MHz pulsed wave diagnostic transcranial Doppler (TCD) for 2-hours after IV-TPA bolus for early recanalization (ER). ER was assessed using the Thrombolysis in Brain Ischemia grading TCD system. Arterial patency was assessed on day 2 in patients who underwent CT angiography or magnetic resonance angiography, labeled as delayed recanalization (DR). Absence of recanalization on early TCD or imaging on day 2 was called persistent arterial occlusion (PAO). Favorable functional outcomes at 3 months were determined by modified Rankin scale (mRS) of 0-1. Results: Of the 2238 AIS patients admitted during the study period, 240 (11%) received IV-TPA within 4.5-hours of symptom-onset. Median age was 65yrs (range 19-92), 63% males, median NIHSS 17points (range 3-35) and median onset-to-treatment time 149 minutes. Overall, 122 (50.8%) patients achieved favorable functional outcome at 3-months. Information about ER, DR and PAO was available for 160 patients- ER in 55(34.4%), DR in 44(27.5%) and PAO in 61(38.1%) patients. Timing of recanalization was associated with favorable outcome (ER 72.7%, DR 63.6% and PAO 31.1%; p<0.005). Factors associated with favorable outcome at 3-months on univariable analysis were younger age, female gender, atrial fibrillation, baseline NIHSS, onset-to-treatment time and timing of recanalization. However, on multivariable analysis, NIHSS at onset (OR per 1-point increase 0.907, 95%CI 0.848-0.969), ER (OR 3.32, 95%CI 1.295-9.474) and DR (OR 3.021 95%CI 1.197-7.634) were found as independent predictors of favorable outcome at 3-months. Conclusions: Timing of arterial recanalization induced by IV-TPA in acute ischemic stroke is a strong predictor of favorable outcome at 3-months.

Pediatric Hyperacute Arterial Ischemic Stroke Pathways at Canadian Tertiary Care Hospitals

2021 ◽  
pp. 1-8
Author(s):  
Maria Gladkikh ◽  
Hugh J. McMillan ◽  
Andrea Andrade ◽  
Cyrus Boelman ◽  
Ishvinder Bhathal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Tertiary Care ◽  
Pediatric Stroke ◽  
Arterial Ischemic Stroke ◽  
Pediatric Hospitals ◽  
First Choice ◽  
Similarities And Differences ◽  
Pre Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
Iv Tpa

ABSTRACT: Background: Childhood acute arterial ischemic stroke (AIS) is diagnosed at a median of 23 hours post-symptom onset, delaying treatment. Pediatric stroke pathways can expedite diagnosis. Our goal was to understand the similarities and differences between Canadian pediatric stroke protocols with the aim of optimizing AIS management. Methods: We contacted neurologists at all 16 Canadian pediatric hospitals regarding AIS management. Established protocols were analyzed for similarities and differences in eight domains. Results: Response rate was 100%. Seven (44%) centers have an established AIS protocol and two (13%) have a protocol under development. Seven centers do not have a protocol; two redirect patients to adult neurology, five rely on a case-by-case approach for management. Analysis of the seven protocols revealed differences in: 1) IV-tPA dosage: age-dependent 0.75–0.9 mg/kg (N = 1) versus age-independent 0.9 mg/kg (N = 6), with maximum doses of 75 mg (N = 1) or 90 mg (N = 6); 2) IV-tPA lower age cut-off: 2 years (N = 5) versus 3 or 10 years (each N = 1); 3) IV-tPA exclusion criteria: PedNIHSS score <4 (N = 3), <5 (N = 1), <6 (N = 3); 4) first choice of pre-treatment neuroimaging: computed tomography (CT) (N = 3), magnetic resonance imaging (MRI) (N = 2) or either (N = 2); 5) intra-arterial tPA use (N = 3) and; 6) mechanical thrombectomy timeframe: <6 hour (N = 3), <24 hour (N = 2), unspecified (N = 2). Conclusions: Although 44% of Canadian pediatric hospitals have established AIS management pathways, several differences remain among centers. Some criteria (dosage, imaging) reflect adult AIS literature. Canadian expert consensus regarding IV-tPA and endovascular treatment should be established to standardize and implement AIS protocols across Canada.

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