April 11, 2019

The shiny new toy in stroke treatment is endovascular therapy.  There have now been 12 randomized controlled trials (RCTs) on endovascular stroke therapy (EST), with eight of the last nine showing positive results – stunningly positive.  This flood of positive trials has led to new guidelines from the American Heart Association (AHA) and American Stroke Association (ASA)that extend the treatment window potentially as far out as 24 hours after last known well, and has spawned a movement to completely overhaul how we deliver care for patients with acute ischemic stroke (AIS). With all of the enthusiasm for EST, it is important to review the evolution of this new approach, to review and critique the evidence, and to evaluate what this means in clinical practice.

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. 

March 15, 2018

Background: Approximately 80% of strokes are ischemic in origin leading to significant morbidity and mortality worldwide.  In ischemic stroke, there is usually a core infarct and an ischemic penumbra.  The penumbra is the area that we try to salvage with reperfusion therapy. Currently, systematic intravenous alteplase administered within 4.5hrs after symptom onset is the mainstay of therapy, however many question its risk/benefit ratio in ischemic stroke. 4.5 hours is a narrow therapeutic time window and many contraindications such as recent surgery, coagulation abnormalities, and history of intracranial hemorrhage inhibit many patients from receiving systemic thrombolysis.  There have been many studies evaluating endovascular therapy in the management of ischemic stroke published in the past few years.  This post will serve as a review of those studies.