In this post, I link to and excerpt from NeuroEMCrit – Time is Brain – Acute Ischemic Stroke Part I: Vascular Syndromes and Thrombolysis
February 15, 2022 by NeuroEMCrit Team (Casey & Neha)
All that follows is from the above outstanding resource.
About ~800K people have a stroke in the US every year (1 person every 40 seconds) and stroke is a leading cause of serious long-term disability (PMID: 31992061). But prior to ~2015, outside of trials, the acute ischemic stroke patient either arrived within 4.5 hours and got tPA or they got supportive care. And, unfortunately, very few patients arrive within the 4.5 hour time window.
Things are dramatically different now. The endovascular era in stroke care has revolutionized care for patients with large vessel occlusions (LVO) – which is the subgroup of patients that before the reperfusion era accounted for the highest stroke morbidity and mortality. There is now effective treatment for those who present within 24 hours.
If nothing else, we hope this post impresses on you the importance of treating ischemic stroke like an MI or any other intervenable condition.
TIME IS BRAIN, and with 1.9 million neurons being lost with every minute of delay, it is important to have acute ischemic stroke codes down cold (PMID: 16339467).
This post reviews the basics of stroke care including some pearls about neuroimaging and then reviews some of the major trials of 2021; the results of which are already transforming stroke care now.