Acute Stroke Treatment KPNC Stroke EXPRESS
|
|
- Madeleine Gilmore
- 5 years ago
- Views:
Transcription
1 Acute Stroke Treatment 2018 KPNC Stroke EXPRESS EXpediting the PRocess of Evaluating & Stopping Stroke 1 Jeffrey G. Klingman, MD The Permanente Medical Group
2 Stroke Treatment in the old days Prior to 1996: back corner of Emergency Department
3 1996: Revolution in Stroke Treatment : IV t-pa ; IV alteplase (t-pa) < 3 hours Number Needed to Treat (NNT) = 4 to prevent major disability Faster is better
4 2011: IV Alteplase to 4.5 hours 2011 IV Alteplase window expands to 4.5 hours No benefit beyond 4.5 hours
5 2013: Endovascular Stroke Treatment (EST) does NOT work 2013: 3 studies - no benefit to endovascular treatment vs IV alteplase N Engl J Med 2013 MR RESCUE Embolectomy was not superior to standard medical care in patients with either a favorable penumbral pattern or a nonpenumbral pattern IMS III Randomly assigned eligible patients who had received intravenous t-pa within 3 hours after symptom onset to receive additional endovascular therapy or ntravenous t-pa alone. The study was stopped early because of futility SYNTHESIS Endovascular therapy is not superior to standard treatment with intravenous t-pa.
6 2016: EST does work (in selected patients) 2016: 4 studies show benefit of endovascular treatment in some stroke patients up to 6 hours Still time sensitive Many fewer patients qualify Difference from 2013 was patient selection and devices
7 2018: The Window Extends : 6 to 24 hours 2018: DAWN and DEFUSE - 3: benefit to 6-24 and 6-16 hours in highly selected Large Vessel Occlusion (LVO) patents NNT 2-3 DAWN DEFUSE 3 Hours Rankin < 2 < 3 NIHSS > 9 > 5 CTA LVO in M1 or ACA LVO in M1 or ACA Core < 70ml on advanced imaging <70ml AND mismatch ratio of >1.8 AND penumbra of >15ml on advanced imaging
8 What would it take to Achieve world class (15-20 minutes) door to needle (DTN) times? Obtain very rapid CT angiogram (CTA) performance and interpretation? Treat, evaluate, and transfer for endovascular therapy very quickly 8
9 Stroke EXPRESS: Key Components Early Stroke Neurologist Video Engagement Rapid assessment Early alteplase ordering Processes redesigned for maximal efficiency Direct to CT and CTA Alteplase administered in CT suite Nearly all patients receive a CTA Rapid Transfer for EST If potential candidate for EST, ambulance pre-ordered before CT/CTA completed Stroke. 2018;49:
10 Population evaluation by teleneurologist Early Stroke Neurologist Video Engagement Every patient is seen and evaluated on arrival by teleneurologist Standardized searchable notes including Stroke alerts cancelled on arrival and why Strokes treated and outcomes including NIHSS exam Presence and location of LVO Transfers for EST
11 Results
12 Results
13 True or False? More patients are eligible for treatment with IV alteplase than are treated with endovascular therapy. A. True B. False Endovascular Therapy IV alteplase 0% 0% True False Response Counter 20
14 Endovascular therapy is rare 18 acute strokes were evaluated to find 1 patient eligible for EST 2546 patients eligible for acute stroke treatment were identified and brought to us by paramedics. Of these patients, 1241 (48.7%) had acute strokes. 600 Treated with IV Alteplase (4X as many as EST) Of the acute strokes, 638 (25%) were potential candidates for endovascular treatment (NIHSS >7) Of these, 141 patients (5.5% of total / 22% of high score) ended up actually having large vessel occlusion and received endovascular therapy.
15 What about the extended window patients? Unknown number of patients will qualify for treatment Nobody has reported number screened for DAWN or DEFUSE 3 EXTEND IA found 70 candidates for treatment out of 549 patients with LVO (13%) 1.7% of all stroke patients (45/2667) qualified for DAWN criteria in one recent study Systems of care need to be prepared to screen potential late window patients Last known well Baseline Rankin NIHSS > 5 (or >9) CT shows no bleed CTA shows occlusion CTP (or MRI) shows small core / perfusion mismatch
16 Endovascular Stroke Treatment Time is brain / faster is better EST is an infrequent, highly specialized treatment Many more patients need IV alteplase than EST (80%) Not all centers should do EST Like may procedural specialties experience and volume matters Minimum 30 treatments per centers per year and 12 per doc per site Rapid identification of EST, patient selection, and transfer is the key
17 Conclusions Acute stroke is a treatable condition Time is critical High functioning primary stroke centers are the key to successful treatment Rapid clinical evaluation Rapid IV alteplase Rapid CTA (Rapid CTP / MRI for late presenting patients) Rapid transfer of selected patients to endovascular treatment centers High functioning Endovascular Stroke Treatment Centers Expedited patient acceptance Adequate volume Excellent treatment times and results
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
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 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 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 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 informationCT 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:
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 informationEndovascular 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,
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 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 informationframework 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
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 informationWhere 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
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 informationPeriinterventional 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
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 informationStroke 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 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 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 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 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 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 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 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 informationEndovascular 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
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 information1/19/2018. 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
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 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 informationIntravenous thrombolysis State of Art. Carlos A. Molina Stroke Unit. Hospital Vall d Hebron Barcelona
Intravenous thrombolysis State of Art Carlos A. Molina Stroke Unit. Hospital Vall d Hebron Barcelona Independent predictors of good outcome after iv tpa Factor SE OR(95%CI) p Constant 0.467(0.69) Recanalization
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 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 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 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 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 informationDisclosures. 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
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 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 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 informationInterventions to Improve Acute Ischemic Stroke Treatment Times
Baptist Health South Florida Scholarly Commons @ Baptist Health South Florida All Publications 3-19-2018 Interventions to Improve Acute Ischemic Stroke Treatment Times Jayme Strauss Baptist Hospital of
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 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 informationAdvances 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
More informationJointly provided by Potomac Center for Medical Education and Rockpointe Supported by an educational grant from Genentech, A Member of the Roche Group
Jointly provided by Potomac Center for Medical Education and Rockpointe Supported by an educational grant from Genentech, A Member of the Roche Group Faculty Speakers Deepak L. Bhatt, MD, MPH, FACC, FAHA,
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 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 informationBY MARILYN M. RYMER, MD
Lytics, Devices, and Advanced Imaging The evolving art and science of acute stroke intervention. BY MARILYN M. RYMER, MD In 1996, when the US Food and Drug Administration (FDA) approved the use of intravenous
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 informationAcute Stroke Care: the Nuts and Bolts of it. ECASS I and II ATLANTIS. Chris V. Fanale, MD Colorado Neurological Institute Swedish Medical Center
Acute Stroke Care: the Nuts and Bolts of it Chris V. Fanale, MD Colorado Neurological Institute Swedish Medical Center ECASS I and II tpa for patients presenting
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 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 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 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 informationIntra-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
More informationCode 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
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 informationGUIDELINES 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
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 informationACUTE 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
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 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 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 informationCOMPREHENSIVE 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
More informationA Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke
T h e n e w e ngl a nd j o u r na l o f m e dic i n e original article A Trial of Imaging Selection and Endovascular Treatment for Ischemic Stroke Chelsea S. Kidwell, M.D., Reza Jahan, M.D., Jeffrey Gornbein,
More informationOngoing Acute Stroke Studies 10/5/2015
Ongoing Acute Stroke Studies 10/5/2015 Wade S. Smith, MD, PhD Director UCSF Neurovascular Service Daryl R. Gress Professor of Neurocritical Care and Stroke Disclosures NIH U10 NS 086494 (PI) NorCal RCC
More informationEndovascular Therapy for Acute Ischaemic Stroke in Northern Ireland. Ian Rennie Interventional Neurologist On behalf of the Belfast trust stroke team
Endovascular Therapy for Acute Ischaemic Stroke in Northern Ireland Ian Rennie Interventional Neurologist On behalf of the Belfast trust stroke team Belfast Team Evidence base we rely on ESCAPE trial Acute
More informationUpdate 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
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 informationStroke Thrombolysis. Dr Peter Anderton (Stroke Consultant DBTH)
Stroke Thrombolysis Dr Peter Anderton (Stroke Consultant DBTH) Thrombolysis for ischaemic stroke Rationale Restoration of blood flow Salvage of ischaemic penumbra Schematic of the mismatch model for defining
More informationEmergency 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
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 informationAntithrombotics: 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
More informationWhat is the best imaging protocol for LVO screening when outside of 0-6h window?
Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention Zentrum für Radiologie und Endoskopie WLNC, Los Angeles/CA, USA, May 15-17, 2017 What is the best imaging protocol for LVO screening
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 informationHIE Image Sharing for a Statewide Stroke Network Session #68, March 6, 2018 Karan Mansukhani, MPH, MBA, Program Manager, Chesapeake Regional
HIE Image Sharing for a Statewide Stroke Network Session #68, March 6, 2018 Karan Mansukhani, MPH, MBA, Program Manager, Chesapeake Regional Information System for our Patients (CRISP) Dr. Michael Phipps,
More informationOptimizing Care for Patients with Acute Ischemic Stroke Thrombolytic Therapy for Low NIHSS
Optimizing Care for Patients with Acute Ischemic Stroke Thrombolytic Therapy for Low NIHSS Nerses Sanossian, MD, FAHA Presentation not eligible for CME credit Disclosures Today s objectives Case study:
More informationENDOVASCULAR THERAPIES FOR ACUTE STROKE
ENDOVASCULAR THERAPIES FOR ACUTE STROKE Cerebral Arteriogram Cerebral Anatomy Cerebral Anatomy Brain Imaging Acute Ischemic Stroke (AIS) Therapy Main goal is to restore blood flow and improve perfusion
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 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 informationSupplementary Online Content
Supplementary Online Content Badhiwala JH, Nassiri F, Alhazzani W, et al. Endovascular Thrombectomy for Acute Ischemic Stroke: A Meta-analysis. JAMA. doi:10.1001/jama.2015.13767. etable 1. The modified
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 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 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 informationFurther 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
More informationUpdate on Neurologic Emergencies
Update on Neurologic Emergencies KAREN GREENBERG, DO, FACOEP ARIA JEFFERSON HEALTH SYSTEM VIRTUA HEALTH SYSTEM KENNEDY HEALTH SYSTEM Disclosures Genentech Speakers Bureau I have disclosed a relevant relationship
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 informationCode 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?
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 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 informationInterventional Revolution in Treatment of Stroke
TCT RUSSIA 2018 XX Moscow s International Course on Endovascular Therapies Moscow, Russia, May 18-20, 2018 Interventional Revolution in Treatment of Stroke Horst Sievert, Ilona Hofmann, Laura Vaskelyte,
More informationIV tpa and mechanical thrombectomy case selection
IV tpa and mechanical thrombectomy case selection 22 April 2017, 9.50-10.30 Deidre De Silva SGH campus, NNI, Singapore OUTLINE Reperfusion concept Case Selection factors IV tpa & Mechanical Thrombectomy
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 informationELVO 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
More informationEpidemiology. Epidemiology 6/1/2015. Cerebral Ischemia
Presenter Disclosure Information Paul Nyquist MD/MPH FCCM FAHA Updates on the Acute Care of Ischemic Stroke and Intracranial Hemorrhage Updates on the Acute Care of Ischemic Stroke Paul Nyquist MD/MPH,
More informationEndovascular 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
More informationCurrent 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,
More informationUpdate on Neurointerventional Therapies: Stroke and Aneurysms
Update on Neurointerventional Therapies: Stroke and Aneurysms Gary Duckwiler, MD Professor and Director Division of Interventional Neuroradiology David Geffen School of Medicine at UCLA Long Beach Memorial
More informationDisclosures. Anesthesia for Endovascular Treatment of Acute Ischemic Stroke. Acute Ischemic Stroke. Acute Stroke = Medical Emergency!
Disclosures Anesthesia for Endovascular Treatment of Acute Ischemic Stroke I have nothing to disclose. Chanhung Lee MD, PhD Associate Professor Anesthesia and perioperative Care Acute Ischemic Stroke 780,000
More informationAcute 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
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 information