Code Stroke Intervention: Endovascular Therapies for Stroke J. DIEGO LOZANO MD INTERVENTIONAL NEURORADIOLOGY
|
|
- Shauna Woods
- 5 years ago
- Views:
Transcription
1 Code Stroke Intervention: Endovascular Therapies for Stroke J. DIEGO LOZANO MD INTERVENTIONAL NEURORADIOLOGY
2 Disclosures None
3 Part A. Objectives Epidemiology of AIS and of ELVO Concept: Acute Ischemic Stroke Emergent Large Vessel Occlusion (AIS-ELVO) Know about NIH Stroke Scale and modified Rankin Scale Update on guidelines and current medical and endovascular management of AIS-ELVO Who to treat? When to treat? Cases Management from RN perspective, before and after endovascular therapy
4 Acute Ischemic Stroke Someone in the US has a stroke about once every 40 seconds. ~ 795,000 new or recurrent strokes each year 610,000 are first attacks 5th leading cause of death in US #1 cause of adult disability *AHA Stroke Facts, 2017
5 ACUTE ISCHEMIC STROKE Risk factors Prior TIA or stroke DM Family history of atherosclerosis CAD PAD aka PVD Atrial fibrillation CHF Dilated cardiomyopathy HTN Lack of physical activity Metabolic syndrome Advanced age Overweight/Obesity Smoking HLD High LDL, low HDL Sickle cell disease
6
7 ELVO-A New Era LVO-Prelude to a New Era Emergent Public awareness Stroke systems of care LVO (Large Vessel Occlusion) Device/technique maturation Appropriate patient selection Proof of benefit
8 ELVO Stroke-Time is Brain 1.8 million neurons lost each minute Probability of a good outcome reduced 10% every 30 minutes until treated *Stroke 2006; 37:
9 AIS-ELVO a Team Effort Community Education EMS appropriate triage to CSC Rapid ED evaluation and triage to endovascular Acute Neurology/ Neuro IR Endovascular specialty consultation t-pa and/or Embolectomy Neurocritical care Rehabilitation Risk factor modification
10 AIS-ELVO Severe trauma STEMI ELVO Advanced trauma care Level I Trauma Ctr. Cath Lab PCI Facility Endovasc. Tx. Comprehensive Stroke Ctr. Evidence based Evidence based Evidence based
11 Acute ischemic stroke Emergent Large Vessel Occlusion (AIS-ELVO) 101
12 Anterior cerebral circulation and posterior cerebral circulation David S. Liebeskind Stroke. 2003;34: Copyright American Heart Association, Inc. All rights reserved.
13 What do we consider a Large Vessel ANTERIOR CIRCULATION Occlusion amenable to thrombectomy? Acute blockage of a proximal great vessel Internal carotid artery cervical and/or intracranial Proximal Middle Cerebral Artery (MCA) M1 segment M2 segment POSTERIOR CIRCULATION Acute blockage of a proximal great vessel Vertebro basilar / Basilar trunk Posterior cerebral artery (PCA) P1 segment/p2 segment M3 segment (?) Proximal Anterior Cerebral Artery (ACA) A1 segment A2 segment
14 ELVO Stroke-Clinical Small Vessel Stroke Weakness (Common face=arm=leg) Sensory less common Dysarthria (slurred speech) common No cortical signs Large Vessel Stroke Weakness (Common face=arm>leg) Sensory common CORTICAL signs Aphasia Gaze preference Visual field cut Neglect/Agnosia
15 Code Stroke Code Stroke Intervention Code Stroke HOB flat unless contraindicated Determine time of symptom onset or last known well Determine neurological deficits / Determine mrs Continuous monitoring of vital signs HR, BP, pulse oximetry Draw labs. 20 G i.v access (ideally x 2), forearm or above Avoid placing i.v. in dorsum of hand CT/CTA Consult Neurology / Neurointerventionalist i.v TPA if eligible Code Stroke Intervention if ELVO and eligible
16 26 y.o. Female acute onset of weakness and difficulty speaking. Last known well 1 hour prior to admission
17 Diagnosis? Which side is the vessel occluded? Right or left? Which vessel is likely occluded? A. Left Internal Carotid Artery (ICA)? B. Left middle cerebral artery (MCA)? C. Left anterior cerebral artery (ACA)? D. Left posterior cerebral artery (PCA)? E. Basilar artery?
18
19 ELVO Stroke-Time IV thrombolysis with t-pa hours Level IA evidence based IV window Thrombectomy studies: treated within 6 hours Level IA evidence-based IA window Thrombectomy devices are FDA-approved up to 8 hours (Anterior circulation) Trevo, Penumbra, Solitaire, other experimental devices Some patients may benefit beyond 6-8 hours Area of active research interest DAWN study Thrombectomy in up to 24 hours of last known well
20 Stroke Trials: Outcome from 5 RCTs
21 AHA/ASA Guidelines 2015 AH/ASA focused update of the 2013 guidelines for the Early Management of Patients with AIS regarding endovascular treatment Class I, LOE A: Endovascular Therapy Pts should receive IAT if they: Have baseline mrs < 1, received i.v. r-tpa, ICA or M1 occlusion > 18 y/o NIHSS > 6 ASPECTS > 6 Start treatment within 6 hrs (LOE A, new) If considering IAT, vessel imaging recommended but should not delay IV r-tpa (LOE A, new)
22 AHA/ASA Guidelines Class IIB; LOE C Treatment initiated (groin puncture) within 6 hours of symptom onset causative occlusion of the M2 or M3 portion of the MCAs, anterior cerebral arteries, vertebral arteries, basilar artery, or posterior cerebral arteries
23 AHA/ASA Guidelines Class IIB; LOE C Treatment initiated (groin puncture) beyond 6 hours of symptom onset causative occlusion of the ICA Proximal MCA M1 segment Additional randomized trial data needed
24 AHA/ASA Guidelines Class IIB; LOE B-R: Although benefits are uncertain Treatment initiated (groin puncture) within 6 hours of symptom onset Prestroke MRS of >1 ASPECTS < 6 NIHSS < 6 Causative occlusion: ICA or M1-MCA Additional RCT needed
25 Risks - complications i.v. TPA Symptomatic intracranial hemorrhage: 6.4% A potential life-threatening complication Typically occurs in the core of the infarct. sich mortality rate = 47% Serious systemic hemorrhages: ~1.6% Orolingual angioedema: 1.3% - 5.1% Endovascular mechanical thrombectomy sich 5% Emboli to new vascular territory 2% Vessel dissection 3% Vasospasm of the access vessel 3% Groin complications: % Minor: hematoma, AV fistula, pseudo-aneurysm Major: vascular death, vascular repair, vessel occlusion, or bleeding with > 3g Hb drop.
26 Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al; ESCAPE Trial Investigators. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372: doi: /NEJMoa
27 26 y.o. Female acute onset of weakness and difficulty speaking. Last known well 1 hour prior to admission
28 26 yo Female: Left Brain Stroke Before After
29 26 y.o. Female: Left Brain Stroke
30 Modified Rankin Scale 0 Symptoms 1- No clinically significant disability 2 Slight disability (patient is able to look after own affairs without assistance but is unable to carry out all previous activities 3 - Moderate disability (patient requires some help but is able to walk unassisted) 4 - Moderately severe disability (patient is unable to attend to bodily needs without assistance and unable to walk unassisted) 5 Severe disability (patient requires constant nursing care and attention) 6 - Death
31 Pre stroke intervention - RNs Document LSW. Document mrs pre stroke disability status (or lack thereof) NIHSS HOB flat, provided no contraindications I.v. fluids with NS (avoid hypotonic solutions) initially at maintenance or at the discretion of MD SBP < 180 but above 150 while LVO is recanalized Labs: most important for Neurointerventionalist: H&H, BUN/creatinine, PLT, PT/INR i.v. TPA if eligible. Document pedal pulses. Groin shave. Complete MRI checklist
32
33
34
35 (A) Left MCA Occlusion (B) Cerebral angiogram before (left) and after (right) mechanical thrombectomy of a proximal artery occlusion in the left MCA (C) Stent retriever
36 Case #43 60 y.o, h.o a-fib off A/C, mrs 0, LSW 1 hour prior to CT scan. NIHSS 19: left hemiplegia, left facial droop, left hemisensory deficit, left Neglect, right gaze preference, dysarthria
37
38
39 Case # y/o female mrs 0, h/o recent left knee arthroplasty, HTN, DM, HLD, Afib, LKW 5:30 pm NIHSS 6: Left facial droop and left upper extremity drift with decreased grip strength in left hand i.v. r-tpa
40 NeuroIR decision making: LKW: Less than 6 hours mrs 1, NIHSS 6 ASPECT score 10 Collaterals: Excellent CTA: Right M2 occlusion
41
42 Beyond the guidelines for IAT Late presenters,6-24 hours from last seen well. Wake up strokes Patients with low NIHSS (<6) but with AIS-ELVO mrs 2-3, assessed on individual basis. Tandem occlusion (intra and extra cranial ipsilateral occlusions) Posterior circulation LVOs Providence LCOM is taking these patients. Imaging protocol may be tailored to each patient: CT/CTA/CTP vs. CT/CTA/MRI/MRP
43 Case #14 52 y/o male, mrs 0, HTN, DM, HLD LKW: midnight Wakes up at 7 am with left sided weakness, couldn t get out of bed EMS called Neurologist evaluated: NIHSS 7: Left lower extremity drift, left upper extremity flaccid, minor left facial droop, severe left sided sensory loss
44 7:18 am 7:26 am 8:15 am
45
46 Case #45 87 y.o female, mrs 3, h.o a-fib off A/C, recent ICH, on in patient rehab, LSW 9:30 am, NIHSS 33
47
48
49
50
51
52 Post endovascular therapy with or w.o i.v TPA Post procedure CT brain Transfer to ICU, HOB flat 1 st hour May raise HOB 30 degrees after an hour, provided no groin hematoma or bleeding SBP < mmhg Nicardipine gtt NPO. i.v. fluids Neuro checks and limb checks q 15 min x 4, q 30 min x 2, q 1 hour Followup CT brain ~ 6-12 hours. Follow up 24 hours PT/OT/ST and neurology to follow
Stroke Update Elaine J. Skalabrin MD Medical Director and Neurohospitalist Sacred Heart Medical Center Stroke Center
Stroke Update 2015 Elaine J. Skalabrin MD Medical Director and Neurohospitalist Sacred Heart Medical Center Stroke Center Objectives 1. Review successes in systems of care approach to acute ischemic stroke
More informationUpdate on Early Acute Ischemic Stroke Interventions
Update on Early Acute Ischemic Stroke Interventions Diana Goodman MD Lead Neurohospitalist Maine Medical Center Assistant Professor of Neurology, Tufts University School of Medicine I have no disclosures
More informationThe DAWN of a New Era for Wake-up Stroke
The DAWN of a New Era for Wake-up Stroke Alan H. Yee, D.O. Stroke and Critical Care Neurology Department of Neurology University of California Davis Medical Center Objectives Review Epidemiology and Natural
More informationEndovascular Treatment of Ischemic Stroke
Endovascular Treatment of Ischemic Stroke William Thorell, MD Associate Professor Neurosurgery UNMC Co-Director Stroke and Neurovascular Center Nebraska Medicine Overview Definitions of terms Review basic
More informationEndovascular Treatment for Acute Ischemic Stroke: Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington
Endovascular Treatment for Acute Ischemic Stroke: Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington Disclosures: SWIFT PRIME site (Medtronic) Physician Proctor
More informationEndovascular Treatment Updates in Stroke Care
Endovascular Treatment Updates in Stroke Care Autumn Graham, MD April 6-10, 2017 Phoenix, AZ Endovascular Treatment Updates in Stroke Care Autumn Graham, MD Associate Professor of Clinical Emergency Medicine
More informationUnclogging The Pipes. Zahraa Rabeeah MD Chief Resident February 9,2018
Unclogging The Pipes Zahraa Rabeeah MD Chief Resident February 9,2018 Please join Polleverywhere by texting: ZRABEEAH894 to 37607 Disclosures None Objectives Delineate the differences between TPA vs thrombectomy
More informationMechanical Thrombectomy: Where Are We Now? T. Adam Oliver, MD Tallahassee Neurological Clinic Tallahassee, Florida TMH Neurosymposium June 11, 2016
Mechanical Thrombectomy: Where Are We Now? T. Adam Oliver, MD Tallahassee Neurological Clinic Tallahassee, Florida TMH Neurosymposium June 11, 2016 none DISCLOSURES Where did we come from? Spiotta, et
More informationEndovascular Neurointervention in Cerebral Ischemia
Endovascular Neurointervention in Cerebral Ischemia Beyond Thrombolytics Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington 72 y/o female with a recent diagnosis
More informationCase 1 5/26/2017 ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE
ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE Rhonda Whiteman Racing Against the Clock Workshop June 1, 2017 Objectives To discuss the hyperacute ischemic stroke management
More informationCVA Updates Karen Greenberg, DO, FACOEP. Director Neurologic Emergency Department Crozer Chester Medical Center
CVA Updates 2018 Karen Greenberg, DO, FACOEP Director Neurologic Emergency Department Crozer Chester Medical Center Disclosure I have the following financial relationship with the manufacturer of any commercial
More informationACUTE ISCHEMIC STROKE
ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE HHS Stroke Annual Review March 7 and March 8, 2018 Objectives To review the stroke endovascular mechanical thrombectomy evidence
More informationDisclosure. Advances in Interventional Neurology. Disclosure. Natural History of Disease 3/15/2018. Vishal B. Jani MD
Advances in Interventional Neurology Disclosure Vishal B. Jani MD Medical Director Vascular Neurology Consultant Interventional Neurology CHI Health Assistant Professor, Creighton University School of
More informationACUTE ISCHEMIC STROKE. Current Treatment Approaches for Acute Ischemic Stroke
ACUTE ISCHEMIC STROKE Current Treatment Approaches for Acute Ischemic Stroke EARLY MANAGEMENT OF ACUTE ISCHEMIC STROKE Rapid identification of a stroke Immediate EMS transport to nearest stroke center
More informationBasilar artery stenosis with bilateral cerebellar strokes on coumadin
Qaisar A. Shah, MD Patient Profile 68 years old female with a history of; Basilar artery stenosis with bilateral cerebellar strokes on coumadin Diabetes mellitus Hyperlipidemia Hypertension She developed
More informationUPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015
UPDATES IN INTRACRANIAL INTERVENTION Jordan Taylor DO Metro Health Neurology 2015 NEW STUDIES FOR 2015 MR CLEAN ESCAPE EXTEND-IA REVASCAT SWIFT PRIME RECOGNIZED LIMITATIONS IV Alteplase proven benefit
More informationHow to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval
How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular Clot Retrieval Peter Howard MD FRCPC Disclosures No conflicts to disclose How to Interpret CT/CTA for Acute Stroke in the Age of Endovascular
More informationComparison of Five Major Recent Endovascular Treatment Trials
Comparison of Five Major Recent Endovascular Treatment Trials Sample size 500 # sites 70 (100 planned) 316 (500 planned) 196 (833 estimated) 206 (690 planned) 16 10 22 39 4 Treatment contrasts Baseline
More informationImaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital
Imaging Stroke: Is There a Stroke Equivalent of the ECG? Albert J. Yoo, MD Director of Acute Stroke Intervention Massachusetts General Hospital Disclosures Penumbra, Inc. research grant (significant) for
More informationInterventional Neuroradiology. & Stroke INR PROCEDURES INR PROCEDURES. Dr Steve Chryssidis. 25-Sep-17. Interventional Neuroradiology
Interventional Neuroradiology Interventional Neuroradiology & Stroke Dr Steve Chryssidis Interventional Neuroradiology (INR) is a subspecialty within Radiology INR -- broadly defined as treatment by endovascular
More informationCode Stroke!! Amit Kansara, MD, FAHA. Joint EMS Conference Providence Brain and Spine Institute Providence Heart and Vascular Institute
Code Stroke!! Amit Kansara, MD, FAHA Joint EMS Conference Providence Brain and Spine Institute Providence Heart and Vascular Institute February 22, 2019 Patient History: Dispatch 20:45: You are dispatched
More informationAcute Stroke Identification and Treatment
Acute Stroke Identification and Treatment James S. McKinney, MD, FAHA Medical Director, NHRMC Stroke Center SE NC is located in the buckle of the Stroke Belt, seeing the highest stroke incidence and mortality
More informationBroadening the Stroke Window in Light of the DAWN Trial
Broadening the Stroke Window in Light of the DAWN Trial South Jersey Neurovascular and Stroke Symposium April 26, 2018 Rohan Chitale, MD Assistant Professor of Neurological Surgery Vanderbilt University
More informationDrano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients
Drano vs. MR CLEAN Review of New Endovascular Therapy for Acute Ischemic Stroke Patients Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School
More informationEndovascular Treatment for Acute Ischemic Stroke
ular Treatment for Acute Ischemic Stroke Vishal B. Jani MD Assistant Professor Interventional Neurology, Division of Department of Neurology. Creighton University/ CHI health Omaha NE Disclosure None 1
More informationInterventional Stroke Treatment
Interventional Stroke Treatment Vishal B. Jani MD Medical Director Vascular Neurology Consultant Interventional Neurology CHI Health Assistant Professor, Creighton University School of Medicine Omaha,
More informationWHY TIMELINESS MATTERS. W&M Wren Association Lecture Series
WHY TIMELINESS MATTERS April 10, 2018 W&M Wren Association Lecture Series Pankajavalli Ramakrishnan, M.D., Ph.D. Stroke Neurologist and Neurointerventionalist Riverside Regional Medical Center Comprehensive
More informationAcute Stroke Treatment: Current Trends 2010
Acute Stroke Treatment: Current Trends 2010 Helmi L. Lutsep, MD Oregon Stroke Center Oregon Health & Science University Overview Ischemic Stroke Neuroprotectant trials to watch for IV tpa longer treatment
More informationAdvanced Stroke Care in the context of the Cardiovascular Patient
EASTERN MAINE MEDICAL CENTER Advanced Stroke Care in the context of the Cardiovascular Patient Advancing Science in Cardiovascular Care Samoset Conference NOV 8, 2018 Dr. Gillian Gordon Perue Conflict
More informationStroke Treatment Beyond Traditional Time Windows. Rishi Gupta, MD, MBA
Stroke Treatment Beyond Traditional Time Windows Rishi Gupta, MD, MBA Director, Stroke and Neurocritical Care Endovascular Neurosurgery Wellstar Health System THE PAST THE PRESENT 2015 American Heart Association/American
More informationStroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke
Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke Alexander A. Khalessi MD MS Director of Endovascular Neurosurgery Surgical Director of NeuroCritical Care University
More informationMechanical thrombectomy in Plymouth. Will Adams. Will Adams
Mechanical thrombectomy in Plymouth Will Adams Will Adams History Intra-arterial intervention 1995 (NINDS) iv tpa improved clinical outcome in patients treated within 3 hours of ictus but limited recanalisation
More informationUpdates on Endovascular Therapy
Updates on Endovascular Therapy 5 th Annual Intermountain Stroke Conference October 16, 2017 M. Shazam Hussain, MD, FRCP(C), FAHA Director, Cerebrovascular Center Associate Professor, CCLCM Staff, Vascular
More informationManagement of Acute Ischemic Stroke. Learning Objec=ves. What is a Stroke? Jen Simpson Neurohospitalist
Management of Acute Ischemic Stroke Jen Simpson Neurohospitalist Learning Objec=ves Iden=fy signs/symptoms of stroke Recognize pa=ents who may be eligible for treatment of acute stroke What is a Stroke?
More informationInterventional Treatment of Stroke
Interventional Treatment of Stroke Andrew F. Ducruet, MD Barrow Neurological Institute 2018 BNI Stroke Rehab Symposium October 13, 2018 Disclosures Consultant: Medtronic, Penumbra, Cerenovus Lecture Overview
More informationPractical Considerations in the Early Treatment of Acute Stroke
Practical Considerations in the Early Treatment of Acute Stroke Matthew E. Fink, MD Neurologist-in-Chief Weill Cornell Medical College New York-Presbyterian Hospital mfink@med.cornell.edu Disclosures Consultant
More informationMechanical thrombectomy beyond the 6 hours. Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital
Mechanical thrombectomy beyond the 6 hours Mahmoud Rayes, MD Medical Director, Stroke program Greenville Memorial Hospital Disclosures None Worldwide statistics 1 IN 6 people will have a stroke at some
More informationACUTE STROKE TREATMENT IN LARGE NIHSS PATIENTS. Justin Nolte, MD Assistant Profession Marshall University School of Medicine
ACUTE STROKE TREATMENT IN LARGE NIHSS PATIENTS Justin Nolte, MD Assistant Profession Marshall University School of Medicine History of Presenting Illness 64 yo wf with PMHx of COPD, HTN, HLP who was in
More informationEndovascular Stroke Therapy
Endovascular Stroke Therapy Update with Emphasis on Practical Clinical and Imaging Considerations Sachin Kishore Pandey, MD, FRCPC Disclosures I have no relevant financial disclosures or conflict of interest
More informationI n t e r h o s p i t a l Tr a n s fe r s o f t h e A c u t e S t r o ke Pat i e n t E M S G r a n d Ro u n d s : Febr u a r y 2 1,
I n t e r h o s p i t a l Tr a n s fe r s o f t h e A c u t e S t r o ke Pat i e n t E M S G r a n d Ro u n d s : Febr u a r y 2 1, 2 0 1 8 Elaine Skalabrin, MD S t r o k e M e d i c a l D i r e c t o
More informationSize Matters: Differentiating Large Vessel Occlusion (LVO) and Small Vessel Occlusion (SVO) in Stroke
Size Matters: Differentiating Large Vessel Occlusion (LVO) and Small Vessel Occlusion (SVO) in Stroke Charles E. Romero, M.D. UPMC Hamot Great Lakes Neurosurgery & Neurointervention Case 1 83 yo RH F with
More informationStatewide Acute Stroke Triage The Washington Story
Statewide Acute Stroke Triage The Washington Story David Tirschwell, MD, MSc Medical Director of Comprehensive Stroke Care Professor, Department of Neurology UW Medicine Comprehensive Stroke Center at
More informationAcute brain vessel thrombectomie: when? Why? How?
Acute brain vessel thrombectomie: when? Why? How? Didier Payen, MD, Ph D Université Paris 7 Département Anesthesiologie-Réanimation Univ Paris 7; Unité INSERM 1160 Hôpital Lariboisière AP-HParis current
More informationAcute Ischemic Stroke Imaging. Ronald L. Wolf, MD, PhD Associate Professor of Radiology
Acute Ischemic Stroke Imaging Ronald L. Wolf, MD, PhD Associate Professor of Radiology Title of First Slide of Substance An Illustrative Case 2 Disclosures No financial disclosures Off-label uses of some
More informationStrokecenter Key lessons of MR CLEAN study
Strokecenter Key lessons of MR CLEAN study Diederik Dippel Disclosures Funded by the Dutch Heart Foundation Nominal, unrestricted grants from AngioCare BV Medtronic/Covidien/EV3 MEDAC Gmbh/LAMEPRO Penumbra
More informationAcute Stroke Management Conference 2019: Stroke Clinical Vignettes
Acute Stroke Management Conference 2019: Stroke Clinical Vignettes Cynthia Kenmuir MD PhD Director of Stroke Program, UPMC Altoona Director of Neurointerventional Program, UPMC Altoona 2015 Guideline for
More informationACUTE STROKE INTERVENTION: THE ROLE OF THROMBECTOMY AND IA LYSIS
Associate Professor of Neurology Director of Neurointerventional Services University of Louisville School of Medicine ACUTE STROKE INTERVENTION: THE ROLE OF THROMBECTOMY AND IA LYSIS Conflict of Interest
More informationND STROKE Coordinators Case Studies. STEMI and Stroke Conference, Fargo, ND, August 5, 2014
ND STROKE Coordinators Case Studies STEMI and Stroke Conference, Fargo, ND, August 5, 2014 STROKE Coordinator Case Study Essentia Health, Fargo Essentia Health Stroke Alert Process Within 24 hours of Last
More informationStroke: The First Critical Hour. Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP
Stroke: The First Critical Hour Alina Candal, RN, PCC, MICN Kevin Andruss, MD, FACEP Disclosures We have no actual or potential conflicts of interest in relation to this presentation. Objectives Discuss
More informationHow to Manage LVO Stroke with Access Blocked by Cervical Carotid Occlusion
How to Manage LVO Stroke with Access Blocked by Cervical Carotid Occlusion November 1 st, 2017 Johanna T. Fifi, MD Director, Endovascular Ischemic Stroke Associate Professor of Neurology, Neurosurgery,
More informationStroke Update. Lacunar 19% Thromboembolic 6% SAH 13% ICH 13% Unknown 32% Hemorrhagic 26% Ischemic 71% Other 3% Cardioembolic 14%
Stroke Update Michel Torbey, MD, MPH, FAHA, FNCS Medical Director, Neurovascular Stroke Center Professor Department of Neurology and Neurosurgery The Ohio State University Wexner Medical Center Objectives
More informationLatest Advances in the Neurointerventional Treatment of Ischemic Stroke P A C I F I C N E U R O. O R G
Latest Advances in the Neurointerventional Treatment of Ischemic Stroke Neurointerventional Management of Ischemic Stroke 1. Thrombectomy for acute ischemic stroke 2. Carotid artery stenting 3. Management
More informationBetter identification of patients who may benefit from therapy
Jon Jui MD, MPH Large Vessel Occlusion Low rates of re-canalization after tpa Only 25 % of large vessel strokes re-canalization after tpa Newer invasive techniques Solitaire vs Merci Better identification
More informationThe Importance of Stroke Programs in an Acute Care Setting by Debbie Estes, RN, BSN Stroke Program Coordinator, Medical City of Dallas
The Importance of Stroke Programs in an Acute Care Setting by Debbie Estes, RN, BSN Stroke Program Coordinator, Medical City of Dallas Objectives Describe the road to the gold Discuss the importance of
More information11/1/2018. Disclosure. Imaging in Acute Ischemic Stroke 2018 Neuro Symposium. Is NCCT good enough? Keystone Heart Consultant, Stock Options
Disclosure Imaging in Acute Ischemic Stroke 2018 Neuro Symposium Keystone Heart Consultant, Stock Options Kevin Abrams, M.D. Chief of Radiology Medical Director of Neuroradiology Baptist Hospital, Miami,
More information12/4/2017. Disclosures. Study organization. Stryker Medtronic Penumbra Viz Route 92. Data safety monitoring board Tudor G.
12/4/2017 Update on Stroke Trials:Extending the Window DWI or CTP Assessment with Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention with Trevo NP001713
More informationParameter Optimized Treatment for Acute Ischemic Stroke
Heart & Stroke Barnett Memorial Lectureship and Visiting Professorship Parameter Optimized Treatment for Acute Ischemic Stroke December 2, 2016, Thunder Bay, Ontario Adnan I. Qureshi MD Professor of Neurology,
More informationOverview. Introduction. New Interventions for Acute Stroke. New Approaches to hemorrhagic Strokes
Overview New Interventions for Acute Stroke Paula Eboli, MD Department of Neurosurgery Rockwood Clinic, Deaconess Hospital Introduction New Approaches to hemorrhagic Strokes New Approaches to Ischemic
More informationRBWH ICU Journal Club February 2018 Adam Simpson
RBWH ICU Journal Club February 2018 Adam Simpson 3 THROMBOLYSIS Reperfusion therapy has become the mainstay of therapy for ischaemic stroke. Thrombolysis is now well accepted within 4.5 hours. - Improved
More informationStroke 101. Maine Cardiovascular Health Summit. Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013
Stroke 101 Maine Cardiovascular Health Summit Eileen Hawkins, RN, MSN, CNRN Pen Bay Stroke Program Coordinator November 7, 2013 Stroke Statistics Definition of stroke Risk factors Warning signs Treatment
More informationMission: Lifeline Stroke Nebraska
Mission: Lifeline Stroke Nebraska What is Mission: Lifeline Stroke? Mission: Lifeline Stroke is the American Heart Association s national initiative to transform stroke care by focusing efforts on connecting
More informationAdvances in Neuro-Endovascular Care for Acute Stroke
Advances in Neuro-Endovascular Care for Acute Stroke Ciarán J. Powers, MD, PhD, FAANS Associate Professor Program Director Department of Neurological Surgery Surgical Director Comprehensive Stroke Center
More informationMechanical Endovascular Reperfusion Therapy
Get With the Guidelines Stroke Mechanical Endovascular Reperfusion Therapy February 1, 2017 Speaker Lee H. Schwamm, MD Executive Vice Chairman and Director of Stroke/TeleStroke Services, Department of
More informationMechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices
Mechanical Thrombectomy of Large Vessel Occlusions Using Stent Retriever Devices Joey English MD, PhD Medical Director, Neurointerventional Services California Pacific Medical Center Hospitals, San Francisco,
More informationObjectives. Stroke Facts 2/27/2015. EMS in Stroke Care: A Critical Partnership
EMS in Stroke Care: A Critical Partnership Spokane County EMS Objectives Identify the types and time limitations for acute ischemic stroke treatment options Identify the importance of early identification
More informationManagement of intracranial atherosclerotic stenosis (ICAS)/intracranial atherosclerosis
Management of intracranial atherosclerotic stenosis (ICAS)/intracranial atherosclerosis Tim Mikesell, D.O. Oct 22, 2016 Stroke facts Despite progress in decreasing stroke incidence and mortality, stroke
More informationStroke & the Emergency Department. Dr. Barry Moynihan, March 2 nd, 2012
Stroke & the Emergency Department Dr. Barry Moynihan, March 2 nd, 2012 Outline Primer Stroke anatomy & clinical syndromes Diagnosing stroke Anterior / Posterior Thrombolysis Haemorrhage The London model
More informationNeuro-vascular Intervention in Stroke. Will Adams Consultant Neuroradiologist Plymouth Hospitals NHS Trust
Neuro-vascular Intervention in Stroke Will Adams Consultant Neuroradiologist Plymouth Hospitals NHS Trust Stroke before the mid 1990s Swelling Stroke extension Haemorrhagic transformation Intravenous thrombolysis
More information5/31/2018. Interventional Therapies that Expand Time Windows for Acute Ischemic Stroke Treatment. Disclosures. Impact of clot burden
Good Outcome (%) Rankin 0-2 at 90 days 5/31/2018 Interventional Therapies that Expand Time Windows for Acute Ischemic Stroke Treatment Disclosures Cerenovus: I am on Executive Committee for ARISE2 Trial
More informationBGS Spring Conference 2015
Neuroradiology in hyperacute stroke: what is the UK position? Dr Shelley Renowden Bristol NICE HIS July, 2013 The current evidence on mechanical clot retrieval for treating acute ischaemic stroke shows
More informationWhat Do You Think of My Posterior?
What Do You Think of My Posterior? Posterior Stroke and Stroke Mimics Peter Panagos, MD, FACEP, FAHA Associate Professor Emergency Medicine and Neurology Washington University School of Medicine Disclosures
More informationStroke Cart Improves Efficiency in Acute Ischemic Stroke Intervention
Stroke Cart Improves Efficiency in Acute Ischemic Stroke Intervention MR Amans, F Settecase, R Darflinger, M Alexander, A Nicholson, DL Cooke, SW Hetts, CF Dowd, RT Higashida, VV Halbach Interventional
More informationCode Stroke in real life. Disclosures. Parkland Memorial Hospital. I have no disclosures. Has 1 million patient visits annually. Level 1 Trauma Center
Code Stroke in real life Alejandro Magadán, M.D. University of Texas Southwestern Medical Center Medical Director for Stroke Parkland Memorial Hospital Disclosures I have no disclosures Parkland Memorial
More informationVivek R. Deshmukh, MD Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine
Vivek R. Deshmukh, MD Director, Cerebrovascular and Endovascular Neurosurgery Chairman, Department of Neurosurgery Providence Brain and Spine Institute The Oregon Clinic Disclosure I declare that neither
More informationFigures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials
Figures for Draft Response to IMS III, MR RESCUE, and SYNTHSESIS Trials Figure 1: Lay Press Judgment May Belie a Deeper Examination of the Data. Truman ultimately defeated Dewey for the Presidency Subject
More informationStroke Systems of Care Claire Corbett, MMS, NRP Manager of Neurodiagnostics and Stroke Center New Hanover Regional Medical Center. What do we know?
Stroke Systems of Care Claire Corbett, MMS, NRP Manager of Neurodiagnostics and Stroke Center New Hanover Regional Medical Center What do we know? Stroke: Time is Brain Shorter onset to treatment times
More informationEvidence for Mechanical ThrombectomyFor Acute Ischemic Stroke. Kenneth V Snyder MD PhD SUNY Buffalo, NY
Evidence for Mechanical ThrombectomyFor Acute Ischemic Stroke Kenneth V Snyder MD PhD SUNY Buffalo, NY Disclosure Speaker name:... I have the following potential conflicts of interest to report: Honorarium
More informationAMSER Case of the Month: March 2019
AMSER Case of the Month: March 2019 62 year-old male with left-sided weakness Ashley Graziano OMS IV, Lake Erie College of Osteopathic Medicine Erik Yannone MD, Charles Q. Li MD, Warren Chang MD, Matthew
More informationIs there even a time window?
Is there even a time window? A brief summary of key 2018 trials: DAWN and DEFUSE-3 For Neurosciences Update Conference, February 22, 2018 Maxim D. Hammer, M.D. Executive Summary Based on DAWN and DEFUSE-3,
More informationPerils of Mechanical Thrombectomy in Acute Asymptomatic Large Vessel Occlusion
Perils of Mechanical Thrombectomy in Acute Asymptomatic Large Vessel Occlusion Aman B. Patel, MD Robert & Jean Ojemann Associate Professor Director, Cerebrovascular Surgery Director, Neuroendovascular
More informationUrgent Care/Triage & Transport of the Severe Stroke Patient in the Field. Robert Knight, BSN, RN, CEN, NRP, CCEMT/P INTEGRIS TeleStroke
Urgent Care/Triage & Transport of the Severe Stroke Patient in the Field Robert Knight, BSN, RN, CEN, NRP, CCEMT/P INTEGRIS TeleStroke Suggested Protocols Suggested protocols are just that. They are not
More informationENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist
ENCHANTED Era: Is it time to rethink treatment of acute ischemic stroke? Kristin J. Scherber, PharmD, BCPS Emergency Medicine Clinical Pharmacist Pharmacy Grand Rounds 26 July 2016 2015 MFMER slide-1 Learning
More informationAcute stroke update 2016 innovations in managing ischemic and hemorrhagic disease
Acute stroke update 2016 innovations in managing ischemic and hemorrhagic disease Christopher Koebbe, MD Endovascular Neurosurgeon Florida Spine Institute Director of Neurosciences Northside Hospital Overview
More informationEVOLUTION IN SYSTEMS OF STROKE CARE RIDWAN LIN, MD, PHD STROKE & INTERVENTIONAL NEUROLOGY BROWARD HEALTH
EVOLUTION IN SYSTEMS OF STROKE CARE RIDWAN LIN, MD, PHD STROKE & INTERVENTIONAL NEUROLOGY BROWARD HEALTH STROKE SYSTEMS OF CARE: 7. Secondary prevention 1. Primary prevention Patient 3. Emergency transport
More informationPrimary Stroke Center Acute Stroke Transfer Guidelines When to Consider a Transfer:
When to Consider a Transfer: Hemorrhagic Stroke Large volume intracerebral hematoma greater than 5cm on CT Concern for expanding hematoma Rapidly declining mental status, especially requiring intubation
More informationDoor to Needle Time: Gold Standard of Stroke Treatment Fatima Milfred, MD. Virginia Mason Medical Center March 16, 2018
Door to Needle Time: Gold Standard of Stroke Treatment Fatima Milfred, MD Virginia Mason Medical Center March 16, 2018 2016 Virginia Mason Medical Center No disclosure 2016 Virginia Mason Medical Center
More informationSlide 1. Slide 2. Slide 3 EMS STROKE CARE AND CSTAT OREGON STROKE NETWORK CONFERENCE 2018 SHAWN WOOD, CLINICAL MANAGER DISCLOSURES MY PATH TO EMS
Slide 1 EMS STROKE CARE AND CSTAT OREGON STROKE NETWORK CONFERENCE 2018 SHAWN WOOD, CLINICAL MANAGER METRO WEST AMBULANCE Slide 2 DISCLOSURES No Financial Conflicts. I work as the Clinical Manager for
More informationESCAPE Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times
ESCAPE Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times Michael D Hill, Mayank Goyal on behalf of the ESCAPE Trial
More informationWV Appalachian Stroke Network 2016 State Stroke Conference The Big Decision Packaging the Patient for Transfer
WV Appalachian Stroke Network 2016 State Stroke Conference The Big Decision Packaging the Patient for Transfer Dr. Jim Kyle, FACSM, FAAFP Regional Medical Director WVOEMS Executive Director, The Kyle Group
More informationMaximising Delivery of Thrombectomy
Maximising Delivery of Thrombectomy Professor Gary Ford Chief Executive Officer, Oxford Academic Health Science Network Consultant Stroke Physician, Oxford University Hospitals Visiting Professor of Clinical
More informationAlex Abou-Chebl, MD Associate Professor of Neurology and Neurosurgery Director of Neurointerventional Services Director of Vascular and
Alex Abou-Chebl, MD Associate Professor of Neurology and Neurosurgery Director of Neurointerventional Services Director of Vascular and Interventional Neurology Fellowships University of Louisville School
More informationThrombectomy with the preset stent-retriever. Insights from the ARTESp* trial
Thrombectomy with the preset stent-retriever Insights from the ARTESp* trial Wiebke Kurre, MD Klinikum Stuttgart - Germany * Acute Recanalization of Thrombo-Embolic Ischemic Stroke with preset (ARTESp)
More informationCarotid Embolectomy and Endarterectomy for Symptomatic Complete Occlusion of the Carotid Artery as a Rescue Therapy in Acute Ischemic Stroke
This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/oa-license), applicable to the online version of the article
More informationTop 5 Big Things in Acute Stroke Care! Raymond W. Grams II, DO Vascular Neurology Stroke Medical Director DRMC, Intermountain Healthcare
Top 5 Big Things in Acute Stroke Care! Raymond W. Grams II, DO Vascular Neurology Stroke Medical Director DRMC, Intermountain Healthcare Late Time Window Endovascular Trials 48.6% WITH intervention vs
More informationIMAGING IN ACUTE ISCHEMIC STROKE
IMAGING IN ACUTE ISCHEMIC STROKE Timo Krings MD, PhD, FRCP (C) Professor of Radiology & Surgery Braley Chair of Neuroradiology, Chief and Program Director of Diagnostic and Interventional Neuroradiology;
More informationDisclosure. + Outline. What is a stroke? Role of imaging in stroke Ischemic stroke Venous infarct Current topics
+ Kathleen R. Fink, MD University of Washington 5 th Nordic Emergency Radiology Course May 21, 2015 + Disclosure My spouse receives research salary support from: Bracco BayerHealthcare Guerbet Thank you
More informationStroke Belt Consortium
Field Triage And Diversion of Acute Stroke Charles Sand, MD Stroke Belt Consortium 10/26/12 WCF EMS Acute Stroke Advisory Committee Formed 2001 5 Original members Now > 100 members interdisciplinary expertise
More informationMichael Horowitz, MD Pittsburgh, PA
Michael Horowitz, MD Pittsburgh, PA Introduction Cervical Artery Dissection occurs by a rupture within the arterial wall leading to an intra-mural Hematoma. A possible consequence is an acute occlusion
More informationDISCLOSURES OBJECTIVES 11/18/2014. Stroke Network Update. None. Discuss
Stroke Network Update MOUHAMMAD A. JUMAA MD ASSISTANT PROFESSOR VASCULAR & INTERVENTIONAL NEUROLOGY UNIVERSITY OF TOLEDO DISCLOSURES None OBJECTIVES Discuss Regional stroke systems of care in NW OHIO Evolution
More information2018 Early Management of Acute Ischemic Stroke Guidelines Update
2018 Early Management of Acute Ischemic Stroke Guidelines Update Brandi Bowman, PhC, Pharm.D. April 17, 2018 Pharmacist Objectives Describe the recommendations for emergency medical services and hospital
More information