Stroke – JournalFeed

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There was no significant difference in intracranial hemorrhage, serious systemic hemorrhage, or inpatient mortality for patients who used non-vitamin K oral anticoagulants in the seven days prior to receiving alteplase for acute ischemic stroke.

Source
Association of Recent Use of Non-Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA. 2022 Feb 22;327(8):760-771. doi: 10.1001/jama.2022.0948.

Mar 24 2022March 27, 2022

CHOICE RCT – Post-Thrombectomy tPA for Stroke

Pharmacy/Pharmacology, Stroke

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Among patients with acute ischemic stroke with large vessel occlusion that have been successfully reperfused with thrombectomy, the use of post-thrombectomy adjunctive intra-arterial alteplase results in greater likelihood of excellent neurologic outcome at 90 days – modified-Rankin score 0 or 1 – when compared with placebo.

Source
Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Feb 10;e221645. doi: 10.1001/jama.2022.1645. Online ahead of print.

Mar 22 2022March 27, 2022

Early Endovascular Therapy for Basilar Artery Occlusion

Neurology, Stroke

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Time from symptom onset of a basilar artery occlusion (BAO) to endovascular therapy (EVT) of less than 6 hours compared to greater than 6 hours (up to 24 hours) was associated with lower odds of in-hospital mortality, disability, symptomatic intracranial hemorrhage, and higher odds of ambulation at discharge, discharge home and reperfusion.

Source
Association Between Endovascular Therapy Time to Treatment and Outcomes in Patients with Basilar Artery Occlusion. Circulation. 2022 Jan 20. doi: 10.1161/CIRCULATIONAHA.121.056554. Online ahead of print.

Dec 7 2021February 28, 2022

Should We Give Alteplase before Endovascular Treatment for Stroke?

Neurology, Pharmacy/Pharmacology, Stroke

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Probably. Endovascular treatment (EVT) alone was neither superior nor noninferior to intravenous (IV) alteplase followed by EVT with regards to disability outcome at 90 days after a stroke.

Jun 18 2021February 28, 2022

BASICS RCT – Endovascular Therapy for Basilar Artery Occlusion

Neurology, Pharmacy/Pharmacology, Stroke

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There was no statistical difference in endovascular therapy compared with usual medical therapy for patients with basilar artery occlusion.

Mar 11 2021March 1, 2022

Canadian TIA Score Beats ABCD2

Landmark, Neurology, Stroke

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The Canadian TIA Score has now been validated and is ready for clinical use. Patients with a clinically-defined TIA (no MRI) may be accurately stratified as low, medium, or high risk for subsequent stroke (+/- carotid revascularization) within 7 days.

Jan 18 2021March 1, 2022

CT vs MRI for Extended Stroke Onset Imaging – Which Is Faster?

Imaging, Neurology, Stroke

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Multimodal CT-based imaging led to faster treatment time than MRI for stroke patients with >4.5 hours or unknown time of onset.

Dec 3 2020March 2, 2022

Rant – More HINTS We Have a Problem

Neurology, Stroke

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HINTS was misapplied 97% of the time by emergency physicians in patients with dizziness. Five patients that clinicians thought had central vertigo by HINTS all did not. Four of six patients who had proven central vertigo all had intermittent symptoms that sounded more like benign positional vertigo. I give up…

Nov 20 2020March 3, 2022

Neurons or Nephrons – Creatinine Screening for Stroke Imaging

Imaging, Pharmacy/Pharmacology, Renal, Stroke

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Elimination of creatinine pre-screening before IV contrast in patients with suspected stroke did not change rates of contrast induced nephropathy, hemodialysis, or mortality.

Aug 31 2020March 3, 2022

Acute Ischemic Stroke – Spoon-Feed Version

Neurology, Stroke

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No matter what you think about tPA (alteplase), this is a quick clinical practice summary to consider when you are taking care of your next stroke patient.