Thrombolytics and Beyond
|
|
- Mervyn Hawkins
- 5 years ago
- Views:
Transcription
1 Thrombolytics and Beyond Greenville Memorial Rodney Leacock MD
2 Introduction 795,000 strokes per year in the US 87% ischemic 13% hemorrhage, 3% SAH Fourth leading cause of death - was third Mortality rate has decreased by 34.8% Leading cause of disability Over 7 million stroke survivors South Carolina is 4th in stroke mortality 34.3 billion dollars / year Direct cost 18.8 Billion AHA/ASA Heart and Stroke Statistics 2012: Circulation : 125
3 Sacco et al Stroke 2006 Introduction Stroke An interruption in the blood flow to the brain, spinal cord TIA (transient ischemic attack) a temporary ischemic neurologic deficit of less than 24 hours duration most minutes duration prevalence 5 million ABCD2 score for TIAs 10 % risk of stroke in 2 days 17% risk of stroke in 90 days 1/3 +ve infarction on MRI ACT FAST Medical emergency call 911
4
5
6 Stroke Belt
7 Mobile Care Ambulance Service Stroke Themed Ambulance 40,000 miles/year Provide transport services throughout region
8 TIME IS BRAIN 1.9 MILLION NEURONS LOST PER MINUTE ISCHEMIC BRAIN LOOSES 3.6 YEARS PER HOUR Working against the clock Saver JL Stroke 2006
9
10
11
12 IV Thrombolysis NINDS trial; NEJM 1995 IV Alteplase (rt-pa) vs placebo; multicenter randomized controlled N = 624 Onset of ictus < 3 hours.9 mg/kg iv Maximum 90 mg 10 % as bolus remainder over one hour
13 IV Thrombolysis rt-pa group significantly better than placebo at 3 months Symptomatic ICH risk 6.4% vs 0.6% Significant Mortality 17% vs 21% FDA approved June 1996
14 IV Thrombolysis With development of Stroke Systems of Care JC PSC (Primary Stroke Centers) JC CSC (Comprehensive Stroke Centers) Public and Professional awareness and education Legislature supporting local, regional, state, and national initiatives and best practices Thrombolytic use is increasing Remains under utilized
15 Stroke Alerts Stroke Alerts Group page/text Neuro CT Lab Pharm PPC Charge nurses (Jan- Sept) Other Sites HMH Greer IP GMH
16 GHS - IV t-pa for Stroke (YTD) GMH Drip & Ship
17 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 IV tpa Median Times Door to IV tpa Times - Median
18 Relation of onset-to-treatment time (OTT) and excellent final functional outcome (mrs 0 1 at 90 days) for intravenous tissue plasminogen activator (IV TPA). Saver J. Stroke 2012;44: Copyright American Heart Association
19 Telestroke Consult in Action Greer, Hillcrest, Baptist Easley, Laurens, Oconee, Newberry, AnMed
20 Telestroke Door-to- Needle Sep-13 Aug-13 Jul-13 Jun-13 May-13 Apr-13 Mar-13 Feb-13 Jan-13 Dec-12 avg Telestroke Consult Times (Median) 0:24 0:11 0:19 0:11 0:15 0:09 0:19 0:11 0:24 0:15 0:14 0:13 0:26 0:13 0:15 0:22 0:12 0:09 0:18 0:21 0:11 0:17 0:12 0:29 0:27 0:34 0:34 0:32 0:30 0:38 0:34 0:35 0:33 0:07 0:12 0:09 0:18 0:11 0:30 0:16 0:16 0:23 0:08 0:12 0:00 0:30 1:00 1:30 2:00 2:31 Door - GHS SA page Consult start - TPA rec SA Page - consult start TPA rec - TPA admin
21 GHS Goal GHS Median min MUSC Median min Ga Median Door to Consult Request Start to tpa decision Request to Consult Start Decision to tpa start MUSC data from May 2008-April 2011 for 231 pts treated w/ IV tpa. Published March 14, 2012 in Frontiers in Neurology doi: /fneur Ga data from Mar 2011-Nov2012 for 115 pts treated w/ IV tpa. Published online July 9, 2013 in Stroke: Journal of the American Heart Association.
22 PROACT II Second multicenter study to determine the efficacy of IA thrombolysis for MCA occlusion within 6 hours 180 patients were randomized rpro-uk 121;control - 59 Median NIHSS 17; median time to treatment was 5.3 hours Neurological deterioration occurred 11/ 108 (10%) Symptomatic ICH were more commonly seen in patients with baseline NIHSS of 11 or more Immediate recanalization rates rpro-uk 66%; control 18 % At 90 days 40 % of the rpro-uk group and 25% of controls achieved an mrs of 2 or less 25% and 27% mortality respectively Furlan et al. JAMA 1999
23 Recanalization Rates MERCI (2004) 57.3%; 69.5 % with ia tpa adjunct Penumbra (2008) reported 87% or better recanalization rate Solitaire (2011) compared with MERCI 83.3% vs 48.1 % recanalization rate (SWIFT 2012) Pro-ACT II(1999) 57.7% rt-pa (Mazighi et al, Lancet Neurology 2009) 52%
24 Example of thrombolysis in cerebral infarction (TICI) 0 and TICI 2b. Zaidat O et al. Stroke 2013;44: Copyright American Heart Association
25 Example of thrombolysis in cerebral infarction (TICI) 1 and TICI 3. Zaidat O et al. Stroke 2013;44: Copyright American Heart Association
26 Thrombolysis rate (A) and median arrival-tissue-type plasminogen activator (tpa) time (B) by onset-arrival time for each of the 3 groups of thrombolysis volume. Bray B et al. Stroke 2013;44: Copyright American Heart Association
27 Median arrival-scan (A) and arrival-tissue-type plasminogen activator times (B) by hospital annual thrombolysis volume. Bray B et al. Stroke 2013;44: Copyright American Heart Association
28 Violin plot of arrival-tissue-type plasminogen activator (tpa) times by thrombolysis volume. Bray B et al. Stroke 2013;44: Copyright American Heart Association
29 Thrombolytics Any thrombolytic therapy 19.20% 16% 13.20% GMH treatment rates high Time to treatment fast Complication rates low GWTG-Strok: 2013 Jan-Jun GMH All SC Hospitals JC PSC Hospitals Time to Intravenous Thrombolytic Therapy (DTN < 60 min) 90.60% Thrombolytic Complications 5.10% 58.30% 57.50% 2.30% 2.80% GMH All SC Hospitals JC PSC Hospitals GMH All SC Hospitals JC PSC Hospitals
30
31 Rates of IV-tPA use within 3 hours of onset over time, in all ischemic stroke cases regardless of time of arrival or any tpa contraindications (solid line) and among fully tpa-eligible AIS patients arriving 2 hours (dashed line). Schwamm L et al. Circ Cardiovasc Qual Outcomes 2013;6: Copyright American Heart Association
32 Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Enhanced Regimen Stroke Trial by Arthur M. Pancioli, Opeolu Adeoye, Pamela A. Schmit, Jane Khoury, Steven R. Levine, Thomas A. Tomsick, Heidi Sucharew, Claudette E. Brooks, Todd J. Crocco, Laurie Gutmann, Thomas M. Hemmen, Scott E. Kasner, Dawn Kleindorfer, William A. Knight, Sharyl Martini, James S. McKinney, William J. Meurer, Brett C. Meyer, Alexander Schneider, Phillip A. Scott, Sidney Starkman, Steven Warach, and Joseph P. Broderick Stroke Volume 44(9): August 26, 2013 Copyright American Heart Association
33 Schematic of blinded administration of recombinant tissue plasminogen activator (rt-pa) plus eptifibatide vs standard rt-pa. Pancioli A et al. Stroke 2013;44: Copyright American Heart Association
34 Ultrasound Identification and Lysis of Clots by Andrei V. Alexandrov Stroke Volume 35(11 suppl 1): November 1, 2004 Copyright American Heart Association
35 Figure 1. Abnormal thrombolysis in brain ischemia (TIBI) flow grades (upper left images), and acute middle cerebral artery occlusion location on magnetic resonance angiography (white arrows) with relative ultrasound transducer position on the skull (white i... Alexandrov A. Stroke 2004;35: Copyright American Heart Association
36 Figure 2. Complete early middle cerebral artery recanalization on power-motion transcranial Doppler and serial NIHSS scores (upper row). Alexandrov A. Stroke 2004;35: Copyright American Heart Association
37 CLOTBUST-Hands Free by Kristian Barlinn, Andrew D. Barreto, April Sisson, David S. Liebeskind, Mark E. Schafer, John Alleman, Limin Zhao, Loren Shen, Luis F. Cava, Mohammad H. Rahbar, James C. Grotta, and Andrei V. Alexandrov Stroke Volume 44(6): May 24, 2013 Copyright American Heart Association
38 A, Operator-independent ultrasound device. Barlinn K et al. Stroke 2013;44: Copyright American Heart Association
39 Conclusion Acute Stroke is a medical emergency Act FAST(ER); Call 911/EMS Intravenous thrombolysis remains most effective therapy for acute ischemic stroke Larger volume centers shorter door to needle times Administration rate is increasing Nearly double over past 10 plus years (4% - 7%) Adjunctive therapies show promise with proven safety
40
Door 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 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 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 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 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 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 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 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 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 informationAdvancing Stroke Systems of Care to Improve Outcomes Update on Target: Stroke Phase II
Advancing Stroke Systems of Care to Improve Outcomes Update on Target: Stroke Phase II Gregg C. Fonarow MD, Eric E. Smith MD, MPH, Jeffrey L. Saver MD, Lee H. Schwamm, MD UCLA Division of Cardiology; Department
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 informationStroke, 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
More informationStroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke
Stroke Clinical Trials Update Transitioning to an Anatomic Diagnosis in Ischemic Stroke Alexander A. Khalessi MD MS Director of Endovascular Neurosurgery Surgical Director of NeuroCritical Care University
More informationMechanical thrombectomy in Plymouth. Will Adams. Will Adams
Mechanical thrombectomy in Plymouth Will Adams Will Adams History Intra-arterial intervention 1995 (NINDS) iv tpa improved clinical outcome in patients treated within 3 hours of ictus but limited recanalisation
More 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 informationStroke Cart Improves Efficiency in Acute Ischemic Stroke Intervention
Stroke Cart Improves Efficiency in Acute Ischemic Stroke Intervention MR Amans, F Settecase, R Darflinger, M Alexander, A Nicholson, DL Cooke, SW Hetts, CF Dowd, RT Higashida, VV Halbach Interventional
More informationACUTE STROKE TREATMENT IN LARGE NIHSS PATIENTS. Justin Nolte, MD Assistant Profession Marshall University School of Medicine
ACUTE STROKE TREATMENT IN LARGE NIHSS PATIENTS Justin Nolte, MD Assistant Profession Marshall University School of Medicine History of Presenting Illness 64 yo wf with PMHx of COPD, HTN, HLP who was in
More 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 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 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 informationPractical Considerations in the Early Treatment of Acute Stroke
Practical Considerations in the Early Treatment of Acute Stroke Matthew E. Fink, MD Neurologist-in-Chief Weill Cornell Medical College New York-Presbyterian Hospital mfink@med.cornell.edu Disclosures Consultant
More informationEndovascular Neurointervention in Cerebral Ischemia
Endovascular Neurointervention in Cerebral Ischemia Beyond Thrombolytics Curtis A. Given II, MD Co-Director, Neurointerventional Services Baptist Physician Lexington 72 y/o female with a recent diagnosis
More 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 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 informationAcute Stroke Management 2009
Acute Stroke Management 2009 Saving the Brain Conference Royal York Hotel January 24, 2009 Frank L. Silver, MD, FRCPC Director, Toronto West Stroke Program Professor of Medicine (Neurology) University
More informationKPNC 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 informationThe Multi arm Optimization of Stroke Thrombolysis (MOST) Trial
The Multi arm Optimization of Stroke Thrombolysis (MOST) Trial Study Team Principal Investigators: Opeolu Adeoye, University of Cincinnati (Lead) Andrew Barreto, University of Texas Houston Jim Grotta,
More informationUpdated tpa Guidelines: Expanding the opportunity for good outcomes. Benjamin Morrow, MSN RN UPMC Stroke Institute
Updated tpa Guidelines: Expanding the opportunity for good outcomes Benjamin Morrow, MSN RN UPMC Stroke Institute 1 Outline History Current State Review Exclusions: Minor stroke symptoms Severe strokes
More informationAbout 700,000 Americans each year suffer a new or recurrent stroke. On average, a stroke occurs every 45 seconds
UCLA Stroke Center Stroke Facts About 700,000 Americans each year suffer a new or recurrent stroke On average, a stroke occurs every 45 seconds Stroke kills more than 150,000 people a year (1 of every
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 informationParameter Optimized Treatment for Acute Ischemic Stroke
Heart & Stroke Barnett Memorial Lectureship and Visiting Professorship Parameter Optimized Treatment for Acute Ischemic Stroke December 2, 2016, Thunder Bay, Ontario Adnan I. Qureshi MD Professor of Neurology,
More 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 informationUpdate on Stroke in South Carolina: REACHing to Treat More Patients using Telestroke
Update on Stroke in South Carolina: REACHing to Treat More Patients using Telestroke 1 Robert J Adams MS MD Professor of Neuroscience University Eminent Scholar Director South Carolina Center of Economic
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 informationRural emergency department best practice for treatment of acute ischemic stroke
Rural emergency department best practice for treatment of acute ischemic stroke Aubrey J. Hoye, DO Ministry Howard Young Medical Center, Woodruff, WI Ministry Eagle River Memorial Hospital, Eagle River,
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 informationProtocol for IV rtpa Treatment of Acute Ischemic Stroke
Protocol for IV rtpa Treatment of Acute Ischemic Stroke Acute stroke management is progressing very rapidly. Our team offers several options for acute stroke therapy, including endovascular therapy and
More informationManaging the Measures: A Serious Look at Key Abstraction Concepts for the Comprehensive Stroke (CSTK) Measure Set Session 2
Managing the Measures: A Serious Look at Key Abstraction Concepts for the Comprehensive Stroke (CSTK) Measure Set Session 2 January 28, 2015 1 to 3 PM Central Time Continuing Education Credit This course
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 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 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 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 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 informationACUTE STROKE INTERVENTION: THE ROLE OF THROMBECTOMY AND IA LYSIS
Associate Professor of Neurology Director of Neurointerventional Services University of Louisville School of Medicine ACUTE STROKE INTERVENTION: THE ROLE OF THROMBECTOMY AND IA LYSIS Conflict of Interest
More informationRole of recombinant tissue plasminogen activator in the updated stroke approach
Role of recombinant tissue plasminogen activator in the updated stroke approach Joshua Z. Willey, MD, MS Assistant Professor of Neurology Division of Stroke, Columbia University October 2015 jzw2@columbia.edu
More informationEmergency Department Management of Acute Ischemic Stroke
Emergency Department Management of Acute Ischemic Stroke R. Jason Thurman, MD Associate Professor of Emergency Medicine and Neurosurgery Associate Director, Vanderbilt Stroke Center Vanderbilt University,
More informationCanadian 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:
More informationOBJECTIVES: INTRODUCTION ADVANCES IN ACUTE STROKE CARE
Brian A. Stettler, MD Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine Member, Greater Cincinnati/Northern Kentucky Stroke Team Cincinnati, Ohio OBJECTIVES:
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 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 informationIMAGING IN ACUTE ISCHEMIC STROKE
IMAGING IN ACUTE ISCHEMIC STROKE Timo Krings MD, PhD, FRCP (C) Professor of Radiology & Surgery Braley Chair of Neuroradiology, Chief and Program Director of Diagnostic and Interventional Neuroradiology;
More 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 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 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 informationStroke Coordinator: ROI. Author: Debbie Roper, RN, MSN (d.r. Stroke) Vice President of Roper Resources, Inc.
Stroke Coordinator: ROI Author: Debbie Roper, RN, MSN (d.r. Stroke) Vice President of Roper Resources, Inc. debbie@roper-resources.com 214-864-8993 Disclosure Debbie Roper is a speaker for: Genentech Activase
More informationSTROKE TRAINING FOR EMS PROFESSIONALS
1 STROKE TRAINING FOR EMS PROFESSIONALS COURSE OBJECTIVES About Stroke Stroke Policy Recommendations Stroke Protocols and Stroke Hospital Care Stroke Assessment Tools Pre-Notification Stroke Treatment
More informationPARADIGM SHIFT FOR THROMBOLYSIS IN PATIENTS WITH ACUTE ISCHAEMIC STROKE, FROM EXTENSION OF THE TIME WINDOW TO RAPID RECANALISATION AFTER SYMPTOM ONSET
PARADIGM SHIFT FOR THROMBOLYSIS IN PATIENTS WITH ACUTE ISCHAEMIC STROKE, FROM EXTENSION OF THE TIME WINDOW TO RAPID RECANALISATION AFTER SYMPTOM ONSET Hye Seon Jeong, *Jei Kim Department of Neurology and
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 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 informationAcute Ischemic Stroke Imaging. Ronald L. Wolf, MD, PhD Associate Professor of Radiology
Acute Ischemic Stroke Imaging Ronald L. Wolf, MD, PhD Associate Professor of Radiology Title of First Slide of Substance An Illustrative Case 2 Disclosures No financial disclosures Off-label uses of some
More information7 TI - Epidemiology of intracerebral hemorrhage.
1 TI - Multiple postoperative intracerebral haematomas remote from the site of craniotomy. AU - Rapana A, et al. SO - Br J Neurosurg. 1998 Aug;1():-8. Review. IDS - PMID: 1000 UI: 991958 TI - Cerebral
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 informationVote 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
More informationIMAGING IN ACUTE ISCHEMIC STROKE
IMAGING IN ACUTE ISCHEMIC STROKE Timo Krings MD, PhD, FRCP (C) Professor of Radiology & Surgery Braley Chair of Neuroradiology, Chief and Program Director of Diagnostic and Interventional Neuroradiology;
More informationAlex Abou-Chebl, MD Associate Professor of Neurology and Neurosurgery Director of Neurointerventional Services Director of Vascular and
Alex Abou-Chebl, MD Associate Professor of Neurology and Neurosurgery Director of Neurointerventional Services Director of Vascular and Interventional Neurology Fellowships University of Louisville School
More 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 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 informationIt is the nature of a stroke to partly take away the use of a man s limbs and to throw him onto the parish if he had no children to look to
It is the nature of a stroke to partly take away the use of a man s limbs and to throw him onto the parish if he had no children to look to George Eliot The Cripples (1949) All cerebrovascular events in
More informationBackground. 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
More informationCode 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
More informationMechanical thrombectomy with stent retriever in acute ischemic stroke: first results.
Mechanical thrombectomy with stent retriever in acute ischemic stroke: first results. Poster No.: C-0829 Congress: ECR 2014 Type: Scientific Exhibit Authors: M. H. J. Voormolen, T. Van der Zijden, I. Baar,
More informationAndrew Barreto, MD MS Associate Professor of Neurology Stroke Neurologist UTHealth. May 23, 2018
Andrew Barreto, MD MS Associate Professor of Neurology Stroke Neurologist UTHealth May 23, 2018 Disclosure No personal financial relationships with any company. Presentation Outline Definitions, signs
More informationReview: Roadmap to Reperfusion in Acute Ischemic Stroke: from Intra-Venous to Intra-Arterial
Review: Roadmap to Reperfusion in Acute Ischemic Stroke: from Intra-Venous to Intra-Arterial 1 Jindong Xu, MD, PhD and 2 Jin Jun Luo, MD, PhD Abstract Acute ischemic stroke (AIS) is a devastating disease
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 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 informationHistorical. 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
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 informationBGS Spring Conference 2015
Neuroradiology in hyperacute stroke: what is the UK position? Dr Shelley Renowden Bristol NICE HIS July, 2013 The current evidence on mechanical clot retrieval for treating acute ischaemic stroke shows
More 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 informationIschemic Stroke Therapies: Resource Guide
Ischemic Stroke Therapies: Resource Guide Ischemic Stroke Therapies Table of Contents Introduction...1 Stroke Protocol Roadmap...2 Public Awareness...3-4 Emergency Medical Services... 5-6 Emergency Department
More informationStroke: What did we learn in the last year?
Stroke: What did we learn in the last year? J. Claude Hemphill III, MD, MAS Associate Professor of Clinical Neurology and Neurological Surgery University of California, San Francisco Director, Neurocritical
More informationEndovascular 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,
More informationTrial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke
Trial Design and Reporting Standards for Intra-Arterial Cerebral Thrombolysis for Acute Ischemic Stroke Randall T. Higashida, MD; Anthony J. Furlan, MD; for the Technology Assessment Committees of the
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 informationStroke Therapy: Faster is Be*er
1/1/16 Stroke Therapy: Faster is Be*er Alteplase (rt-pa) data (mostly) Stroke 795, each year. 55, first/new strokes 5th Leading Cause of Death in US 129, (CDC 213) We live in the Stroke Belt (highest stroke
More informationAcute Stroke Protocols Modified- What s New in 2013
Acute Stroke Protocols Modified- What s New in 2013 KUMAR RAJAMANI, MD, DM. Vascular Neurologist-MSN Associate Professor of Neurology WSU School of Medicine. Saturday, September 21, 2013 Crystal Mountain
More informationMEDICAL POLICY EFFECTIVE DATE: 12/18/08 REVISED DATE: 12/17/09, 03/17/11, 05/19/11, 05/24/12, 05/23/13, 05/22/14
MEDICAL POLICY SUBJECT: CT (COMPUTED TOMOGRAPHY) PAGE: 1 OF: 5 If the member's subscriber contract excludes coverage for a specific service it is not covered under that contract. In such cases, medical
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 informationFUTURE DIRECTIONS OF STROKE CARE
FUTURE DIRECTIONS OF STROKE CARE Jawad F. Kirmani MD Director Stroke & Neurovascular Center New Jersey Neurological Institute Stroke & Neurovascular Center of New Jersey Mohammad Moussavi, MD, Spozhmy
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 informationSignificant 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
More informationThe principal goal in treating acute ischemic stroke is rapid
ORIGINAL RESEARCH S. Sugiura K. Iwaisako S. Toyota H. Takimoto Simultaneous Treatment with Intravenous Recombinant Tissue Plasminogen Activator and Endovascular Therapy for Acute Ischemic Stroke Within
More informationBuilding a Stroke Portfolio. June 28, 2018
Building a Stroke Portfolio June 28, 2018 1 Forward-Looking Statements This presentation contains forward-looking statements, including statements relating to: the potential benefits, safety and efficacy
More informationTENNESSEE STROKE REGISTRY QUARTERLY REPORT
TENNESSEE STROKE REGISTRY QUARTERLY REPORT Volume 1, Issue 3 September 2018 This report is published quarterly using data from the Tennessee Stroke Registry. Inside this report Data on diagnosis, gender
More informationCurrent treatment options for acute ischemic stroke include
ORIGINAL RESEARCH M.-N. Psychogios A. Kreusch K. Wasser A. Mohr K. Gröschel M. Knauth Recanalization of Large Intracranial Vessels Using the Penumbra System: A Single-Center Experience BACKGROUND AND PURPOSE:
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 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 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 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 informationThe tpa Cage Match. Disclosures. Cage Match. Cage Match 1/27/2014. January 8, Advisory Boards
The tpa Cage Match January 8, 2014 Andy Jagoda, MD, FACEP Professor and Chair of Emergency Medicine Mount Sinai School of Medicine New York, New York Advisory Boards Disclosures Astra Zeneca, Pfizer, CSL
More information