How Quickly and Accurately Can Ischemic Stroke Be Diagnosed and Treated with tPA?

MedicalResearch.com Interview with:

Perttu J. Lindsberg, MD, PhD Professor of Neurology Clinical Neurosciences and Molecular Neurology Research Programs Unit, Biomedicum Helsinki University of Helsinki Helsinki, Finland

Dr. Lindsberg

Perttu JLindsberg, MD, PhD
Professor of Neurology
Clinical Neurosciences and Molecular Neurology
Research Programs Unit, Biomedicum Helsinki
University of Helsinki Helsinki, Finland

MedicalResearch.com: What is the background for this study?

Response: The past 20 years in shaping the Helsinki model in stroke thrombolysis have proven that we can be very fast in examining the patient, completing the imaging and starting thrombolytic therapy. This is a university hospital center that receives roughly three stroke suspects per day for evaluation of recanalization therapies. Already seven years ago we were able to push the median ’door-to-needle’ time permanently below 20 minutes. What we had not been monitoring was how well we had kept up the accuracy of our emergengy department (ED) diagnostic process. Prehospital emergency medical services (EMS) have been trained to focus on suspecting thrombolysis-eligible stroke and we usually get also pre-notifications of arriving stroke code patients during transportation, but the diagnosis on admission is an independent clinical judgment as the CT findings are largely nondiagnostic for acute changes.

The admission evaluation of suspected acute stroke is therefore a decisive neurologic checkpoint, building the success of acute treatments such as recanalization therapy, but is complicated by differential diagnosis between true manifestations of stroke and numerous mimicking conditions. Although we have invested a lot on training and standardized ED procedures, time pressure and therapy-geared expectations may blur the diagnostic process.

With this background, we embarked on an in-depth-analysis of the admission and final diagnoses of stroke code patients, as well as misdiagnoses, immediate treatment decisions and their consequences.

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tPA Plus Mechanical Thrombectomy in Acute Ischemic Stroke?

MedicalResearch.com Interview with:

Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto

Dr. Vitor Mendes Pereira

Vitor Mendes Pereira MD MSc
Division of Neuroradiology – Joint Department of Medical Imaging
Division of Neurosurgery – Department of Surgery
Toronto Western Hospital – University Health Network
Associate Professor of Radiology and Surgery
University of Toronto 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study is a pooled analysis of two large prospective stroke studies that evaluated the effectiveness of mechanical thrombectomy (MT) using one of the stent retrievers (Solitaire device ) in patients with acute ischemic stroke related to large vessel occlusion(LVO). It is known (after 5 randomized controlled trials in 2015) that IV rtPA alone failed to demonstrated benefit when compared to MT associated or not to rtPA. A question is still open: what it is the real benefit of IV rtPA in the context of LVO, particularly in centres that can offer mechanical thrombectomy within 60 minutes after qualifying imaging?

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Only 4% of US Stroke Patients Receive Approved Medication tPA

dr_opeolu_adeoyeMedicalResearch.com Interview with:
Opeolu Adeoye, MD MS FACEP FAHA
Associate Professor, Emergency Medicine and Neurosurgery
Division of Neurocritical Care
University of Cincinnati
Cincinnati, OH 45267

Medical Research: What are the main findings of the study?

Dr. Adeoye : Despite adequate access of the US population to hospitals that can deliver acute stroke care, only 4% of stroke patients in the US received tPA, the only approved medication for treating acute ischemic stroke.
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