Stroke Workflow in 2018

22 Apr
April 22, 2018

With the publication of the DAWN and DEFUSE-3 trials came a new era in stroke management.  We have discussed the specific literature pertaining to endovascular therapy on REBEL EM before in our 2hour CME activity HERE.  Along with the two new publications came the 2018 AHA/ASA guidelines for endovascular therapy in acute ischemic stroke.  Anand Swaminathan and myself wanted to place a stand alone post on the workflow of stroke in 2018. 

AHA/ASA 2018 Guideline Recommendations for Endovascular Therapy:

  • In selected patients with acute ischemic stroke within 6 – 24 hours of last known normal who have large vessel occlusion in the anterior circulation, obtaining CT perfusion, Diffusion weighted MRI, or MRI perfusion is recommended to aid in patient selection for mechanical thrombectomy, but only when imaging and other eligibility criteria from RCTs showing benefit are being strictly applied in selecting patients for mechanical thrombectomy – Level IA
  • In selected patients with acute ischemic stroke within 6 – 16 hours of last known normal who have large vessel occlusion in the anterior circulation and meet other DAWN or DEFUSE 3 eligibility criteria, mechanical thrombectomy is recommended – Level IA
  • In selected patients with acute ischemic stroke within 6 – 24 hours of last known normal who have large vessel occlusion in the anterior circulation and meet other DAWN eligibility criteria, mechanical thrombectomy is reasonable – Level IIa

2018 Stroke Workflow

 

Special Thank You

Evie Grace Marcolini, MD
Assistant Professor of EM
Yale New Haven Hospitla
New Haven, CT
Twitter: @EvieMarcolini

References:

  1. Nogueira RG et al. Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct. NEJM 2017. PMID: 29129127
  2. Albers GW et al. Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging. NEJM 2018.PMID: 29364767
  3. Powers WJ et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke 2018.PMID: 29367334
  4. Teleb MS et al. Stroke Vision, Aphasia, Neglect (VAN) Assessment – A Novel Emergent Large Vessel Occlusion Screening Tool: Pilot Study and Comparison with Current Clinical Severity Indices. J Neurointerv Surg 2017. PMID: 26891627

For More on This Topic Checkout:

Post Peer Reviewed & Edited By: Anand Swaminathan, MD (Twitter: @EMSwami) and Evie Marcolini, MD (Twitter: @EvieMarcolini)

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Salim Rezaie

Emergency Physician at Greater San Antonio Emergency Physicians (GSEP)
Creator & Founder of R.E.B.E.L. EM
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