ACUTE ISCHEMIC STROKE
|
|
|
- Stanley French
- 5 years ago
- Views:
Transcription
1 ENDOVASCULAR MECHANICAL THROMBECTOMY IN PATIENTS WITH ACUTE ISCHEMIC STROKE HHS Stroke Annual Review March 7 and March 8, 2018
2 Objectives To review the stroke endovascular mechanical thrombectomy evidence and the Canadian Best Practice Hyperacute Recommendations related to Mechanical Thrombectomy. To review the emerging Stroke Mechanical Thrombectomy evidence. To review the Stroke Mechanical Thrombectomy Inclusion Criteria, Patient Flow Algorithm and Post Procedural Care and Management.
3 Hyperacute Ischemic Stroke To limit irreversible ischemic damage during an acute ischemic stroke caused by an arterial occlusion. To restore blood flow to the artery by either IV tpa or Stroke Mechanical Thrombectomy to promote reperfusion of viable brain tissue. 1,900,000 brain cells die each minute blood supply is cut off to the brain. Each minute that blood supply is cut off to the brain equates to 1 week of healthy life lost. Management Goals
4 Large Vessel Occlusion (LVO) Large Vessel Occlusions (LVO) are the most serious kinds of ischemic stroke. 20% of all ischemic stroke cases. Occlusion of Proximal internal carotid artery Middle cerebral artery (M1) Anterior cerebral arteries (A1) Vertebral or basilar arteries Restrict blood supply to large portions of the brain causing significant stroke deficits and severe morbidity and mortality.
5 2015 Endovascular Therapy for Large Vessel Acute Ischemic Strokes All of the trials have demonstrated statistically significant differences in: Rate of functional independence in the endovascular stroke clot retrieval group versus the intravenous thrombolysis. NNT ranging from Decrease in mortality in the endovascular stroke clot retrieval group versus intravenous thrombolysis. MR CLEAN No difference ESCAPE in EXTEND-IA symptomatic SWIFT intracerebral PRIME REVASCAT hemorrhage. Three additional RCT s have found similar results as these landmark trials.
6 Hermes Collaboration Analysis of 5 Endovascular Research Trials 1287 patients from 5 EVT RCTs were analysed found benefit for Endovascular Therapy, NNT 2.6 and no differences in ICH or mortality at 90 days. Found Benefit for Endovascular Therapy Men and Women Equally All ages All Anterior Large Artery occlusions All stroke severities Whether patient got tpa or had contraindications for tpa
7 Mechanical Thrombectomy in
8 Who is Eligible for EVT Treatment? 20% of ischemic stroke patients. Those eligible and those ineligible for tpa. Disabling Stroke. Stroke Symptoms within 6 hours of time last seen normal. Large blood vessel blockage with a reachable clot. Brain tissue that is still alive (ASPECTS > 6)
9
10 Baseline Characteristics & Outcomes between Late EVT Trials in the Intervention Group Time from Last Known Well to Randomization DAWN (6 to 24 hours) 12.2 hours ( ) DEFUSE 3 (6 to 16 hours) 10:29 hours ( :40) Witnessed Onset of Stroke 10% 34% Wake Up Stroke 63% 53% Median NIHSS 17 (14 21) 16 (10-20) Infarct Volume on CT Perfusion Improved Functional Independence 7.6 ( ) 19.4 ( ) 35% 28%
11 Who May be Eligible for Treatment Based on New Evidence? 20% of ischemic stroke patients. Those eligible and those ineligible for tpa. Disabling Stroke (NIHSS > 6). Stroke Symptoms last seen well within 6 hours. May consider up to 16 hours from last seen well. Large blood vessel blockage with a reachable clot. Brain tissue that is still alive (ASPECTS > 6).
12 Current Endovascular Centres With 24/7 Coverage 1. Hamilton Health Sciences 2. London Health Sciences 3. Ottawa Hospital 4. St. Michael s Hospital 5. Sunnybrook Health Centre 6. Toronto Western Hospital 7. Trillium Health Partners 8. Kingston General Hospital Without 24/7 Coverage 1. Thunder Bay Regional Hospital 2. Windsor Regional Hospital
13 Central South Stroke Network Stroke Thrombolysis Providers
14 Access to Endovascular Therapy Stroke Protocols and Flow Processes Emergency Medical Services (EMS) Provincial Paramedic Prompt Card to identify stroke in the field EMS Patch to ED to inform ED that a Code Stroke Patient is on route ED to notify the Stroke Team with EMS Patch Emergency Department Rapid ED Triage in ED Rapid Access to CT to rule out hemorrhage and to mcta to identify large vessel occlusion Laboratory Test Stroke Neurology Review of Imaging and Laboratory Results Neurological Assessment (NIHSS) Determine Eligibility for tpa and EVT Consult NeuroInterventional MD if Large Vessel Occlusion NeuroInterventional MD Determine eligibility for Mechanical Thrombectomy Activate Neurointerventional team (IR Nurse and Tech, Clot Retrieval Nurse) Consent for procedure
15 Patient presents with functionally disabling stoke within 6.0 hours of onset of Symptoms at Local Stroke Thrombolysis Centre Initiate Acute Stroke Protocol CT/mCTA Local Site Determine Eligibility for tpa If eligible for tpa - Administer tpa without Delay Goal Door to Needle less than 30 minutes CTA Shows Large Proximal Artery Occlusion Consult Telestroke MD
16 Telestroke Neurologist determines Patient is an Endovascular Mechanical Thrombectomy Case Telestroke Neurologists consults HHS Neurologist and NeuroInterventional Physician via phone and reviews images via ENITS to arrange transfer to HGH for Mechanical Thrombectomy HHS Neurologist accepts transfer to HGH HHS Neurologist arranges a 7 WSDU/ICU Bed for patient Sending Site arranges Code 4 Transfer with a Nurse to HGH DI Pod 2 Patient transferred directly to HGH Diagnostic Imaging Department for CT Head and Evaluation for Mechanical Thrombectomy Patient transferred to DI NeuroInterventional Suite for Mechanical Thrombectomy Goal; Door to Puncture: 60 minutes Transferred to Neurosurgical Stepdown Unit post procedure and Stroke Unit within 24 hours - If stable & SDU demand minimum SDU time 4 hours Repatriate to local Stroke Unit within 24 hours
17 Post Procedural Care of Stroke Mechanical Thrombectomy Patient Sheath Site Complications: May occur within first hours post sheath removal Monitor site for: Bruising Pseudo-aneurysm Retroperitoneal Bleed Excessive Bleeding Peripheral Pulses first hours
18 Post Procedural Care of Stroke Mechanical Thrombectomy Patient Monitor Kidney Function: Patient has received CT contrast for CTA & during procedure so monitor kidney function post procedure IV to flush contrast from kidneys Monitor for Fluid Overload/CHF Watch for fluid overload especially in patients with cardiac co-morbidities Monitor for Cardiac Arrhythmias Atrial Fibrillation Daily ECG X3
19 Acute Stroke Management Blood Pressure: After Mechanical Thrombectomy, BP will normally fall 20 mmhg Maintain 140 and less than 180 depending on patient s previous norm Antithrombotic Therapy Generally wait 24 hours post IV tpa/mechanical Thrombectomy before starting antithrombotic therapy - Wait until 24 hours post CT is completed to rule out bleeding VTE Prophylaxis Generally wait 24 hours post IV tpa/mechanical Thrombectomy before starting pharmacological VTE Wait until 24 hours post CT is completed to rule of bleeding Mechanical Prophylaxis using Intermittent Pneumatic Compression Devices (SCD) may be considered. Do not apply SCD in leg with femoral sheath or for 8 hours post sheath removal. Monitor for post TPA Complications if received IV tpa Repatriation back to local Stroke Unit if regional case Implement Acute Ischemic Stroke Best Practices
20 References 1. Casaubon, L.K., Boulanger, J.M., on behalf of the Hyperacute and Acute Stroke Writing Group. (2015) Hyperacute Stroke Care Module In Lindsay MP, Gubitz G, Bayley M, and Smith EE (Editors) on behalf of the Canadian Stroke Best Practices and Advisory Committee. Canadian Stroke Best Practice Recommendations, 2015; Ottawa, Ontario Canada: Heart and Stroke Foundation. 2. Goyal, M., Menon, B.K., et al. for the Hermes Collaboration. (2016) Endovascular Thrombectomy after large-vessel ischaemic stroke:a metaanalysis of individual patient data from five randomized trials. Lancet. 387: Nogueria, R.G., Jadhav, A.P. et al. for the DAWN Trial Investigators. (2018) Thrombectomy 6 to 24 hours after Stroke with a Mismatch between Deficit and Infarct. New England Journal of Medicine. 378: Albers, G.W., Marks, S. for the DEFUSE 3 Investigators (2018) Thrombectomy for Stroke at 6 to 16 hours with Selection by Perfusion Imaging. New England Journal of Medicine. 379: 1-11.
21 Questions
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
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
Updated Stroke Clinical Handbook: Endovascular Treatment (EVT) and what it means for me
Updated Stroke Clinical Handbook: Endovascular Treatment (EVT) and what it means for me Dr Grant Stotts, Co-Chair, Provincial Endovascular Treatment Steering Committee March 29, 2017 Beth Linkewich, Provincial
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Introduction of Innovation into an Activity-Based Funding System in Ontario Stroke Endovascular Treatment (EVT)
Introduction of Innovation into an Activity-Based Funding System in Ontario Stroke Endovascular Treatment (EVT) Imtiaz Daniel, PhD, MHSc, CPA, CMA Director, Financial Analytics and System Performance,
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
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
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
CVA 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
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
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
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,
EVOLUTION 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
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
2017 Stroke Statistics
2017 Stroke Statistics 2017 LUMC Stroke Volumes by Type of Stroke Ischemic Stroke Treatment by Type 2017 17% 8% 75% Ischemic Intracerebral Hemorrhage Aneurysmal Subarachnoid Hemorrhage 31 42 25 r-tpa Administered
Emergency Treatment of Ischemic Stroke
Emergency Treatment of Ischemic Stroke JEFFREY BOYLE, M.D., PHD CLINICAL DIRECTOR OF STROKE AT AVERA MCKENNAN AVERA MEDICAL GROUP NEUROLOGY SIOUX FALLS, SD Conflicts of Interest None I will discuss therapies
Sentinel Stroke National Audit Programme (SSNAP) Based on stroke patients admitted to hospital for thrombectomy between April 2016 and March 2017
Thrombectomy Sentinel Stroke National Audit Programme (SSNAP) Thrombectomy Report for April 2016 - March 2017 National results July 2017 Based on stroke patients admitted to hospital for between April
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
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
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
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
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
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
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
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,
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
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
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
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 Treatment KPNC Stroke EXPRESS
Acute Stroke Treatment 2018 KPNC Stroke EXPRESS EXpediting the PRocess of Evaluating & Stopping Stroke 1 Jeffrey G. Klingman, MD The Permanente Medical Group Stroke Treatment in the old days Prior to 1996:
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;
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,
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
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
From interventional cardiology to cardio-neurology. A new subspeciality
From interventional cardiology to cardio-neurology. A new subspeciality in the future? Prof. Andrejs Erglis, MD, PhD Pauls Stradins Clinical University Hospital University of Latvia Riga, LATVIA Disclosure
Maximising 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
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
Neuro-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
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
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
Acute 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
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
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
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
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.
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
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
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
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
GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE
2018 UPDATE QUICK SHEET 2018 American Heart Association GUIDELINES FOR THE EARLY MANAGEMENT OF PATIENTS WITH ACUTE ISCHEMIC STROKE A Summary for Healthcare Professionals from the American Heart Association/American
2018 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
Care of the Ischemic Stroke Patient: from ER to wards. Disclosures
Care of the Ischemic Stroke Patient: from ER to wards Jay Shah, MD Assistant Clinical Professor jshah@uci.edu none Disclosures 1 Outline Epidemiology Intravenous thrombolytic Thrombectomy Stroke management
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
Stroke Special Project 640 and 740 Resource For Health Information Management Professionals
Stroke Special Project 640 and 740 Resource For Health Information Management Professionals Linda Gould RPN Erin Kelleher, BA, CHIM Stefan Pagliuso PT, B.A. Kin(Hon.) Overview of this Resource Overview
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
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;
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
Code Stroke Optimizing Stroke Care in the Field: The Alberta Experience
Code Stroke Optimizing Stroke Care in the Field: The Alberta Experience June 1st, 2018 Thomas Jeerakathil BSc, MD, MSc, FRCP(C) Professor Division of Neurology University of Alberta Northern Stroke Lead
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
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
Code Stroke for Hospital Medicine: Clinical Challenges in Inpatient Care
Code Stroke for Hospital Medicine: Clinical Challenges in Inpatient Care William J. Hicks II, MD Co-Director, Comprehensive Stroke Program Riverside Methodist Hospital Columbus, OH What s the big deal?
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
Objectives. 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
ELVO update. Michael Wilder, MD Director, Neurointerventional Program PeaceHealth Sacred Heart Springfield, Oregon
ELVO update Michael Wilder, MD Director, Neurointerventional Program PeaceHealth Sacred Heart Springfield, Oregon Riverbend 24/7 thrombectomy ELVO alert Access PH PACU Anesthesia Goyal et al. Lancet. 2016
Periinterventional management in acute neurointervention
40eme SFNR Congres Paris Periinterventional management in acute neurointervention Peter Berlit Department of Neurology Alfried Krupp Hospital Essen Germany There are 2 evidence based treatment options
Patient selection for i.v. thrombolysis and thrombectomy
3 rd Congress of the European Academy of Neurology Amsterdam, The Netherlands, June 24 27, 2017 Teaching Course 8 Acute treatment and early secondary prevention of stroke Level 2 Patient selection for
Scottish Stroke Improvement Plan. Prof Martin Dennis Chair of National Advisory Committee
Scottish Stroke Improvement Plan Prof Martin Dennis Chair of National Advisory Committee Examples where Stroke Nurses are key to improvement Implementation of Intermittent Pneumatic Compression to reduce
Endovascular therapy using mechanical thrombectomy devices for treatment of patients with ischaemic stroke
Evidence Note 87 December 2018 In response to enquiry from the Thrombectomy Advisory Group Endovascular therapy using mechanical thrombectomy devices for treatment of patients with ischaemic stroke Questions
Current management of acute ischemic stroke in comprehensive stroke center in Japan
SYⅠ-1 Current management of acute ischemic stroke in comprehensive stroke center in Japan Nobuyuki Sakai 1, Hirotoshi Imamura 1, Hidemitsu Adachi 1, Shoichi Tani 1, Ryu Fukumitsu 1, Tadashi Sunohara 1,
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
Endovascular Treatment for Acute Ischemic Stroke: Considerations from Recent Randomized Trials
Published online: March 13, 2015 1664 9737/15/0034 0115$39.50/0 Review Endovascular Treatment for Acute Ischemic Stroke: Considerations from Recent Randomized Trials Manabu Shirakawa a Shinichi Yoshimura
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
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,
Canadian Best Practice Recommendations for Stroke Care. (Updated 2008) Section # 3 Section # 3 Hyperacute Stroke Management
Canadian Best Practice Recommendations for Stroke Care (Updated 2008) Section # 3 Section # 3 Hyperacute Stroke Management Reorganization of Recommendations 2008 2006 RECOMMENDATIONS: 2008 RECOMMENDATIONS:
Thrombolytic therapy should be the first line treatment in acute ishchemic stroke. We are against it!!
Thrombolytic therapy should be the first line treatment in acute ishchemic stroke We are against it!! 85% of strokes are ischaemic, and related to blockage of an artery by a blood clot, so potential treatments
Accepted Manuscript. Expanding the Salvage Time Window of LVO Stroke Patients After Cardiovascular Surgery. SuK Jung Choo, MD, PhD
Accepted Manuscript Expanding the Salvage Time Window of LVO Stroke Patients After Cardiovascular Surgery SuK Jung Choo, MD, PhD PII: S0022-5223(19)30243-0 DOI: https://doi.org/10.1016/j.jtcvs.2019.01.033
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:
SEE IT. BELIEVE IT. THE CONFIDENCE OF CLARITY. Solitaire Platinum. Revascularization Device
SEE IT. BELIEVE IT. THE CONFIDENCE OF CLARITY. Revascularization THE CONFIDENCE OF CLARITY. The key features that make the device effective have been retained including our unique Parametric overlapping
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
Background. Recommendations for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association
for Imaging of Acute Ischemic Stroke: A Scientific Statement From the American Heart Association An Scientific Statement from the Stroke Council, American Heart Association and American Stroke Association
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
Acute Ischaemic Stroke Pathways Drip and Ship
Acute Ischaemic Stroke Pathways Drip and Ship Professor Gary Ford Chief Executive Officer, Oxford Academic Health Science Network Consultant Stroke Physician, Oxford University Hospitals Visiting Professor
The Effect of Diagnostic Catheter Angiography on Outcomes of Acute Ischemic Stroke Patients Being Considered for Endovascular Treatment
The Effect of Diagnostic Catheter Angiography on Outcomes of Acute Ischemic Stroke Patients Being Considered for Endovascular Treatment Adnan I. Qureshi, MD 1, Muhammad A. Saleem, MD 1, Emrah Aytaç, MD
Operation Stroke. How to Reduce the Risk of Stroke Complications
Operation Stroke How to Reduce the Risk of Stroke Complications Objectives Focus on Acute Stroke as an active disease Discuss the most common stroke complications Describe how first 72 hours sets the stage