EVOLUTION IN SYSTEMS OF STROKE CARE RIDWAN LIN, MD, PHD STROKE & INTERVENTIONAL NEUROLOGY BROWARD HEALTH
|
|
|
- Aileen Bridges
- 5 years ago
- Views:
Transcription
1 EVOLUTION IN SYSTEMS OF STROKE CARE RIDWAN LIN, MD, PHD STROKE & INTERVENTIONAL NEUROLOGY BROWARD HEALTH
2 STROKE SYSTEMS OF CARE: 7. Secondary prevention 1. Primary prevention Patient 3. Emergency transport providers Outcome Stroke 2. Community education Pre-hospital care 6. Rehab -physical therapist -occupational therapist -speech therapist -rehab MD 4. Acute stroke Treatment -ER physicians -Neurologist -RN -Laboratory -Radiology -Pharmacy Acute Care Hospital 5. Sub-Acute stroke Treatment Acute Rehab
3 IV TPA PROACT-II MERCI RETRIEVER PENUMBRA SWIF TREVO-2 SWIFT-PRIME MR CLEAN ESCAPE REVASCAT PROGRESS IN STROKE: HISTORICAL PERSPECTIVES PSC CERTIFICATION CSC CERTIFICATION EMS STROKE SYSTEMS OF CARE TIME Decade of the brain *Time is brain 05 DIAS 06 DEFUSE 08 EPITHET *Physiology is brain DAWN
4 STROKE SYSTEMS OF CARE HISTORICAL PERSPECTIVES 1. Early challenges Patient Stroke awareness symptom recognition knowledge of time sensitive treatment EMS activation Pre-hospital providers (EMS) 911 responders to recognize stroke symptoms and rapid dispatch Hospital services Stroke Response team (neurologists, radiologists, ER physicians) Hospital readiness and capabilities
5 ESTABLISHMENT OF STROKE SYSTEMS OF CARE Stroke 2005; 36: Objectives: Promote patient-centered collaborations and interactions amongst stakeholders Adoption of standardized care approach Identify and track performance measures
6 STROKE SYSTEMS OF CARE DEVELOPMENT AND PROGRESS 1. Early challenges Patient Stroke awareness (symptom recognition, knowledge of time sensitive treatment, EMS activation) General prevention efforts (primordial, primary and secondary prevention) Community education & Stroke Pre-hospital providers (EMS) Notification and response AHA/ASA Policy Statement: Implementation Strategies for Emergency Medical Services Within Stroke Systems of Care (2007)
7 EMS WITHIN STROKE SYSTEMS OF CARE EMS communicators recognize signs and symptoms reported by callers Dispatch the highest level of care in the shortest time using emergency medical dispatch guidelines reflecting the current ASA/AHA guidelines Field assessment & triage Transfer protocol
8 STROKE SYSTEMS OF CARE 1. Development and Progress Hospital services Response team (neurologists, radiologists, ER physicians) Brain Attack Team 24/7 availability Support team: neurosurgical and endovascular 24/7 availability Hospital readiness and capabilities Stroke Center Designations (stroke ready, primary, comprehensive stroke centers) Collaborations Amongst various designated stroke centers (drip and ship, hub and spoke models) Stroke Units Workflow & Performance Metrics Door-to-Needle Time for IV thrombolytic therapy (target goal less than 60min) Secondary stroke prevention (anti-thrombotic therapy, anticoagulation) Dysphagia screen & Rehabilitation Education materials for patients and families 90 day outcome
9 THE ESSENCE OF TIME.
10 GOLDEN HOUR FOR IV-TPA WORKFLOW METRICS
11 GET-WITH-THE-GUIDELINES PROGRAM TRACK STANDARDIZED PERFORMANCE METRICS
12 LIMITATIONS OF IV TPA IV-TPA IN LARGE ARTERY STROKES Recanalization rates: ICA-T 12.5% (Jansen et al., AJNR 1995) Extracranial ICA 9% (Wolpert et al., ajnr 1993) MCA 39% (Neumann-Haefelin et al., stroke 2004; Wolpert et al., AJNR 1993) MCA M1 40% MCA M2 66% Vertebrobasilar 40-50% (Lindsberg et al., stroke 2006)
13 IV TPA PROACT-II MERCI RETRIEVER PENUMBRA SWIF TREVO-2 SWIFT-PRIME MR CLEAN ESCAPE REVASCAT EXTEND-IA PROGRESS IN STROKE PSC CERTIFICATION CSC CERTIFICATION EMS STROKE SYSTEMS OF CARE TIME Decade of the brain *Time is brain 05 DIAS 06 DEFUSE 08 EPITHET *Physiology is brain DAWN
14 INTRA-ARTERIAL TREATMENT TRIALS 2015 TRIAL SITES VESSEL TARGETS MR CLEAN Netherlands ICA, M1, M1, A1, A2 EXTEND-IA Australia & New zealand ICA, M1, M2 ESCAPE Canada ICA, M1, M2 (TANDEM ALLOWED) SWIFT- PRIME International ICA, M1 (NO TANDEM) REVASCAT Spain ICA, M1, M2 (TANDEM ALLOWED) IMAGING SELECTION MEDIAN NIHSS ASPECTS 9 (IQR 7-10) 17 (IQR 14-21) CT PERFUSION (RAPID SOFTWARE) ASPECTS 6-10 CTA 50% PIAL FILLING ASPECTS 9 (IQR 7-10) OR CT PERFUSION (RAPID SOFTWARE) 17 (IQR 13-20) 16 IQR (13-20) 17 IQR (13-10) ASPECTS 7 (IQR 6-9) 17 IQR (14-20)
15 INTRA-ARTERIAL TREATMENT TRIALS 2015 TRIAL VESSEL TARGETS STROKE TO GROIN PX MR CLEAN ICA, M1, M1, A1, A2 260 IQR ( ) STROKE TO REPERFUSION TICI 2B-3 NOT REPORTED 58.7% EXTEND-IA ICA, M1, M2 210 IQR( ) ESCAPE ICA, M1, M2 (TANDEM ALLOWED) 185 IQR ( ) 248 IQR IQR % 72.4% SWIFT- PRIME ICA, M1 (NO TANDEM) 224 IQR ( ) 252 IQR * 88% REVASCAT ICA, M1, M2 (TANDEM ALLOWED) 269 IQR ( ) 355 IQR % *STROKE TO STENT-TRIEVER DEPLOYMENT
16 INTRA-ARTERIAL TREATMENT TRIALS 2015 MRS 90D ADJUST COMMON OR FUNCTIONAL INDEPENDENCE SICH MR CLEAN 1.67 ( ) 32.6% (VS 19.1% =13.5%) 7.7% (VS 6.4%) EXTEND-IA % (VS 40% = 31%) 0 (VS 6%) ESCAPE 3.1 ( ) 53% (VS 29.3% = 23.8%) 3.6% (VS 2.7%) SWIFT- PRIME NOT REPORTED 60% (VS 35% = 25%)) 0 (VS 3%) REVASCAT 1.7 ( ) 43.7 (VS 28.2% = 15.5%) % *(VS 1.9%) * SITS-MOST VS ECASS II DEFINITIONS
17 STROKE OUTCOME IS DEPENDENT ON TIME TO TREATMENT EARLY IS BETTER Good clinical outcome after ischemic stroke with successful revascularization is timedependent (Khatri et al., Neurology 2009): Tissue viability 1/time Khatri et al., Neurol 2009
18 INTERVENTIONAL STROKE TREATMENT NEW CHALLENGES 1000 PSCs, CSCs Regionalization of interventional stroke care Triage is key (either field or local hospital) and time driven
19 TIME METRIC FOR INTRA-ARTERIAL STROKE RX PICTURE-TO-PUNCTURE TIME Circulation 2013; 127:
20 TIME METRIC FOR INTRA-ARTERIAL STROKE RX PICTURE-TO-PUNCTURE TIME Circulation 2013; 127:
21 TIME METRIC FOR INTRA-ARTERIAL STROKE RX PICTURE-TO-PUNCTURE TIME Circulation 2013; 127:
22 INTERVENTIONAL STROKE SYSTEMS OF CARE NEW CHALLENGES TRIAGE OF POTENTIAL LVOs Field Triage (identification of LVO) Field assessment scales Stroke Mobile / Ambulance Local hospital Triage (hub and spoke model) No RCT or head-to-head trial data
23 STROKE INTERVENTION SYSTEMS OF CARE NEW CHALLENGES Field Triage (identification of LVO) NIHSS is standard stroke scale NIHSS 12 has PPV of 91% for LVO Field assessment scales (for predicting LVO) Stroke Scale Sensitivity Specificity LAMS 4 81% 89% RACE 5 85% 68% CPSSS 2 83% 40% 3ISS 4 67% 92% Stroke Mobile / Ambulance
24 STROKE INTERVENTION SYSTEMS OF CARE NEW CHALLENGES Pre-Hospital Care Field Triage (identification of LVO) NIHSS is standard stroke scale Field assessment scales (for predicting LVO) Stroke Mobile / Ambulance
25 STROKE INTERVENTION SYSTEMS OF CARE NEW CHALLENGES Hospital care Hospital readiness and capabilities Competing time demands of iv tpa and endovascular treatments) Parallel workflow process Mehta et al., J Am Heart Ass. 2014
26 STROKE INTERVENTION SYSTEMS OF CARE NEW CHALLENGES Hospital care Hospital readiness and capabilities Competing time demands of iv tpa and endovascular treatments) Parallel workflow process Mehta et al., J Am Heart Ass. 2014
27 STROKE INTERVENTION SYSTEMS OF CARE NEW CHALLENGES Hospital care Hospital readiness and capabilities Competing time demands of iv tpa and endovascular treatments) Parallel workflow process Mehta et al., J Am Heart Ass.2014
28 CONCLUSIONS COORDINATED STROKE SYSTEMS OF CARE CRUCIAL TO SURVIVAL AND OUTCOME OF STROKE PATIENTS CARE PROCESS CONTINUE TO EVOLVE TIME IS BRAIN (A CONSTANT) FASTER INITIATION OF TREATMENT BETTER ACUTE TRIAGE (FIELD OR ER) SIMPLE MARKER FOR ACUTE STROKE
29 STROKE STATISTICS 1. Now the fifth leading cause of death in the U.S. Better Prevention Better Treatments Better Infrastructure Guidelines for emergency care providers (ems) Increase In certified stroke centers Brain attack team Organized stroke units Improvement in treatment time (door-to-treatment) Use of get with the guidelines program
30 KNOW THE SIGNS ACT IN TIME! TIME
Stroke, Stroke, Stroke Where Do We Stop on the River? Comprehensive vs. Primary Stroke Centers
Stroke, Stroke, Stroke Where Do We Stop on the River? Comprehensive vs. Primary Stroke Centers Peter D. Panagos, MD, FAHA, FACEP Departments of Neurology and Emergency Medicine Washington University School
Acute 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
Drano 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
Mechanical 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
Interventional 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
Mechanical 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,
Stroke 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
Broadening 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
Disclosures. Current Management of Acute Ischemic Stroke. Overview. Focal brain ischemia. Nerissa U. Ko, MD, MAS Professor of Neurology May 8, 2015
Disclosures Current Management of Acute Ischemic Nerissa U. Ko, MD, MAS Professor of Neurology May 8, 2015 Nothing to disclose Research Funding: American Heart Association NIH/NINDS Selected slides courtesy
Strokecenter 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
UPDATES 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
Acute 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
Mechanical 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
The 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
Endovascular 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
Mechanical 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
DISCLOSURES 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
Endovascular 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
Update 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
Endovascular 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
Stroke 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
Mechanical 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
Endovascular 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
Statewide 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
BGS 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
Stroke 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
Stroke 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
How 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
Updates 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
RBWH 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
Code 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
Antithrombotics: Percent of patients with an ischemic stroke or TIA prescribed antithrombotic therapy at discharge. Corresponding
Get With The Guidelines -Stroke is the American Heart Association s collaborative performance improvement program, demonstrated to improve adherence to evidence-based care of patients hospitalized with
Figures 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
KPNC Stroke EXPRESS EXpediting the PRocess of Evaluating & Stopping Stroke
KPNC Stroke EXPRESS EXpediting the PRocess of Evaluating & Stopping Stroke Jeffrey G. Klingman, MD 1 Disclosures None 75% DTN < 60 50% DTN < 45 Why should we care about DTN?: Time is brain 2 million nerve
ACUTE 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
Stroke: 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
WHY 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
5/31/2018. 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
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
Endovascular 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
Better 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
ESCAPE 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
Getting the Right Stroke Patient to the Right Hospital: Pre-hospital Assessment Tools
Getting the Right Stroke Patient to the Right Hospital: Pre-hospital Assessment Tools Francis X Guyette, MD, MPH Associate Professor of Emergency Medicine University of Pittsburgh School of Medicine Medical
Intra-arterial Stroke Therapy: 2018 Update
Intra-arterial Stroke Therapy: 2018 Update Expanding the Treatment Window Parita Bhuva, M.D. Medical Director Enrolling investigator Stryker Neurovascular (DAWN trial) Disclosures Most common large vessel
Acute 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
Endovascular 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
ACUTE STROKE IMAGING
ACUTE STROKE IMAGING Mahesh V. Jayaraman M.D. Director, Inter ventional Neuroradiology Associate Professor Depar tments of Diagnostic Imaging and Neurosurger y Alper t Medical School at Brown University
ACUTE 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
Interventional 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
Acute Stroke Systems of Care Optimizing Patient Care and Improving Outcomes
Acute Stroke Systems of Care Optimizing Patient Care and Improving Outcomes Laurie Paletz, BSN PHN RN-BC SCRN Cedars-Sinai Medical Center Stroke Program Coordinator Disclosures Speaker s Bureau: Genentech
Advances 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
Evidence 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
DISCLOSURES HUY TRAN MD UNM DEPARTMENT OF NEUROLOGY AND NEUROSURGERY NO DISCLOSURES
DISCLOSURES ANDREW HARRELL MD FAEMS UNM DEPARTMENT OF EMERGENCY MEDICINEUNM EMS MEDICAL DIRECTION CONSORTIUM MEDICAL DIRECTOR, ALBUQUERQUE FIRE DEPARTMENT MEDICAL DIRECTOR, GRAND CANYON NATIONAL PARK TEMS
Acute 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
Imaging 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
Parameter 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,
Illinois Stroke System Policy Overview
Illinois Stroke System Policy Overview Christopher T. Richards, MD, MS, FAEMS Department of Emergency Medicine, Northwestern Feinberg School of Medicine Associate EMS Medical Director, Region XI EMS System
framework for flow Objectives Acute Stroke Treatment Collaterals in Acute Ischemic Stroke framework & basis for flow
Acute Stroke Treatment Collaterals in Acute Ischemic Stroke Objectives role of collaterals in acute ischemic stroke collateral therapeutic strategies David S Liebeskind, MD Professor of Neurology & Director
Vote Using Your Phone!
Update on Stroke Certification Jean Range, MS, RN The Joint Commission February 28, 2014 Vote Using Your Phone! Answer multiple choice questions by texting a code to 22333. Your phone carrier s texting
Case 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
Stroke 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
DISCLOSURES. Learning Objectives. David Lee Gordon, MD, FAHA Update in Stroke 2007 FINANCIAL DISCLOSURE UNLABELED/UNAPPROVED USES DISCLOSURE
Acute Stroke Care and the Role of EMS Ryan Hakimi, DO, MS April 30, 2015 Assistant Professor Director, Critical Care Neurology Department of Neurology University of Oklahoma Health Sciences Center DISCLOSURES
What Have We Learned: Selection for Endovascular Stroke Therapy
What Have We Learned: Selection for Endovascular Stroke Therapy Raul G Nogueira, MD Associate Professor in Neurology, Neurosurgery, and Radiology Emory University Director, Neuroendovascular Service Director,
Advances in Acute stroke Management
Advances in Acute stroke Management Sandra Ripper-Brown, DNP Neuroscience Nurse Practitioner St. Mary s Medical Center WPB, FL Palm Beach County Nurse Practitioner Council Annual Conference APRNs: Agents
IMAGING 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;
Practical 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
Acute Stroke Rescue and Recovery
Acute Stroke Rescue and Recovery Qaisar A. Shah, MD Director, Neurointerventional and Neurocritical care Nancy Arena Gogal,, RN Manager Cath/EPS/Neuro lab AMH Stroke Program Evolution 1997: Stroke Program
Latest 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
Acute Stroke Management What is State of the Art?
Acute Stroke Management What is State of the Art? Karl-Titus Hoffmann Department of Neuroradiologie University of Leipzig / University Hospital Leipzig Disclosure Speaker name: Karl-Titus Hoffmann I have
IMAGING 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;
Interventional 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,
Disclosure. 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
Endovascular Therapy for Acute Ischemic Stroke: Reducing Door-to-puncture Time
DOI: 10.5797/jnet.oa.2016-0140 Endovascular Therapy for Acute Ischemic Stroke: Reducing Door-to-puncture Time Yoichi Morofuji, 1,2 Nobutaka Horie, 1,2 Yohei Tateishi, 2,3 Minoru Morikawa, 4 Eisaku Sadakata,
Team Work in Treatment of Acute Ischemic Stroke
Diagnosis and Treatment in Acute Ischemic stroke July, 15 th 2016. Bach Mai Hospital Team Work in Treatment of Acute Ischemic Stroke Prof. Pham Minh Thong 1 Time is brain Ischemic stroke: big global burden
Code Stroke Intervention: Endovascular Therapies for Stroke J. DIEGO LOZANO MD INTERVENTIONAL NEURORADIOLOGY
Code Stroke Intervention: Endovascular Therapies for Stroke J. DIEGO LOZANO MD INTERVENTIONAL NEURORADIOLOGY Disclosures None Part A. Objectives Epidemiology of AIS and of ELVO Concept: Acute Ischemic
1/19/2018. Endovascular Therapy for Stroke
Endovascular Therapy for Stroke 1 PROACT II (1999, IA urokinase)first to demonstrate benefit of EST Newer trials (including MERCI in 2005) demonstrated vessel recanalization but no clinical benefit 2 Based
Update on Thrombolysis and Thrombectomy. Seniorprofessur Neurologie UniversitätsKlinikum und Universität Heidelberg
Update on Thrombolysis and Thrombectomy Relevant Disclosures I received financial compensation from Boehringer - Ingelheim for my time and efforts as Chairman of the SC of ECASS 1-3 and from Paion for
Endovascular Clot Retrieval. Teddy Wu Neurologist (and Stroke enthusiast) Christchurch Hospital
Endovascular Clot Retrieval Teddy Wu Neurologist (and Stroke enthusiast) Christchurch Hospital Something you can do tomorrow Melbourne half marathon 2016 In 2009 Simple approach to stroke - blocked artery,
Size 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
Primary Versus Comprehensive: What is the Difference?
Primary Versus Comprehensive: What is the Difference? April 26, 2018 Bethann Mercanti, PA-C Director of Clinical Practice Stroke Program Coordinator Cooper Neurological Institute Cooper Bon & Joint Institute
Moving from a Primary Stroke Center to a Comprehensive Stroke Center
Moving from a Primary Stroke Center to a Comprehensive Stroke Center MJ Hampel, MPH, MBA The Joint Commission October 19, 2012 Presenter Disclosure Information MJ Hampel Moving from a Primary Stroke Center
Primary Stroke Center Quality & Performance Measures
Primary Stroke Center Quality & Performance Measures This section of the manual contains information related to the quality performance of Primary Stroke Centers. Brain Attack Coalition Definitions Recognition
Further Pragmatic Trials of Thrombectomy are Needed
Further Pragmatic Trials of Thrombectomy are Needed Prof Keith W Muir Institute of Neuroscience & Psychology University of Glasgow Institute of Neurological Sciences Queen Elizabeth University Hospital
Thrombectomy 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)
Stroke Systems of Care
Comprehensive Stroke and Cerebrovascular Center Stroke Systems of Care Dana Stradling RN MSN CNRN UC Irvine Stroke Manager dstradli@uci.edu Why Stroke Systems? No. 4 th 5 th cause of death in the U.S.
AHA/ASA Guideline. Downloaded from by on November 7, 2018
AHA/ASA Guideline 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular
Urgent 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
CT Perfusion is Essential for Stroke Triage. Maarten Lansberg, MD PhD Associate Professor of Neurology Stanford University, Stanford Stroke Center
CT Perfusion is Essential for Stroke Triage Maarten Lansberg, MD PhD Associate Professor of Neurology Stanford University, Stanford Stroke Center CT Perfusion is Essential for Stroke Triage Disclosures:
COMPREHENSIVE SUMMARY OF INSTOR REPORTS
COMPREHENSIVE SUMMARY OF INSTOR REPORTS Please note that the following chart provides a sampling of INSTOR reports to differentiate this registry s capabilities as a process improvement system. This list
Lessons Learned from IMS III: Implications for the Future
Lessons Learned from IMS III: Implications for the Future Pooja Khatri, MD, MSc Professor, Dept of Neurology Director of Acute Stroke, UC Stroke Team University of Cincinnati Disclosures Univ of Cincinnati
Comparison 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
Code 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
Historical. Medical Policy
Medical Policy Subject: Mechanical Embolectomy for Treatment of Acute Stroke Policy #: SURG.00098 Current Effective Date: 01/01/2016 Status: Revised Last Review Date: 08/06/2015 Description/Scope This
12/4/2017. 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
Endovascular Therapy: Beyond the Guidelines
Endovascular Therapy: Beyond the Guidelines Ashutosh P. Jadhav, MD PhD Assistant Professor, Neurology and Neurological Surgery Center for Neuro-endovascular Therapy UPMC Stroke Institute Pittsburgh, PA
Significant Relationships
Opening Large Vessels During Acute Ischemic Stroke Significant Relationships Wade S Smith, MD, PhD Director UCSF Neurovascular Service Professor of Neurology Daryl R Gress Endowed Chair of Neurocritical
Where are we heading and where are the big challenges?
Where are we heading and where are the big challenges? Christopher Levi Neurologist, John Hunter Hospital, Newcastle & Liverpool Hospital, Sydney Executive Director, Sydney Partnership for Health Education
Distal Mechanical Thrombectomy in Acute Ischemic Stroke Method and Benefit. Hans Henkes, Wiebke Kurre Stuttgart, Germany
Distal Mechanical Thrombectomy in Acute Ischemic Stroke Method and Benefit Hans Henkes, Wiebke Kurre Stuttgart, Germany 1 Thrombectomy... with stent-retrievers is an evidence based therapy for intracranial
Pr Roman Sztajzel Service de Neurologie HUG
Pr Roman Sztajzel Service de Neurologie HUG Conflict of interest: none IV THROMBOLYSIS AND ENDOVASCULAR THROMBECTOMY approved treatments of acute stroke main criteria time (delay) IV thrombolysis radiological
Perils 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