JACC Focus Seminar: Current Best Practices and Future Directions in Stroke
JACC Focus Seminar
Hyperacute Management of Ischemic Strokes: JACC Focus Seminar

https://doi.org/10.1016/j.jacc.2020.03.006Get rights and content
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Highlights

  • IV-rtPA has been the cornerstone of acute ischemic stroke treatment. Recently, mechanical removal of the clot via catheter-based treatment has shown immense effect in the severe type of ischemic stroke.

  • A system-wide effort should streamline the stroke workflow for intravenous thrombolysis as well as for mechanical removal of clot to provide maximum benefit to the patient.

  • More clinical trials are being conducted to further the horizon of acute stroke treatment.

Abstract

Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide. Intravenous tissue plasminogen activator has been a cornerstone for treatment of acute ischemic stroke for more than 20 years; however, its use is limited due to a narrow therapeutic window, several contraindications, and low efficacy to recanalize the artery in large vessel occlusion. Recently, the addition of endovascular mechanical thrombectomy of large artery occlusion has revolutionized the stroke treatment for most disabling strokes. The paper reviews updates to the thrombolytic treatment as well as catheter-based treatment, and results from recent trials in the selection of patients in an extended time window using perfusion imaging.

Key Words

acute ischemic stroke
imaging in acute stroke
IV-rtPA
mechanical thrombectomy
mechanical thrombectomy in extended time window

Abbreviations and Acronyms

AIS
acute ischemic stroke(s)
CTA
computed tomography angiography/angiogram
IV-rtPA
intravenous recombinant tissue plasminogen activator
mRS
modified Rankin score
MT
mechanical thrombectomy
NIHSS
National Institutes of Health Stroke Scale
sICH
symptomatic intracranial hemorrhage
TICI
Thrombolysis In Cerebral Infarction

Cited by (0)

Dr. Yavagal has served as a consultant (modest) to Aldagen/Cytomedix, and Covidien/Medtronic; has served as a steering committee member for SWIFT Prime, RECOVER-Stroke, and MR RESCUE (investigator steering committee); has served as a data and safety monitoring board member for ESCAPE; and is supported by grants from the Florida Biomedical State Grants, CTSI, National Institutes of Health, and Anderson Family Gift. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.