Stroke - An Infarct Rather Than an Accident - The Heart Course

Explore the latest advancements in stroke management through this comprehensive lecture by Dr. Bart Besinger. Delve into the paradigm shift of viewing stroke as an infarct rather than an accident, and understand the implications of the era of mechanical thrombectomy. Learn about current guidelines for treating patients with mild symptoms, those over 80 years old, and cases with rapidly improving symptoms. Examine the management of wake-up strokes, referencing the DAWN and DEFUSE 3 trials. Gain insights into the importance of rapid transport to facilities capable of administering IV alteplase and the criteria for referring patients for possible thrombectomy. Understand the complexities of decision-making in acute stroke care and how to apply emerging data and new guidelines in clinical practice.

Intro
Stroke State of the art
Era of mechanical thrombectomy
Mild symptoms NIHSS 5
AHA/ASA: Intravenous alteplase administration within 3 hours is equally recommended for patients 80 years of age. IA
Rapidly improving symptoms
Intravenous alteplase treatment is reasonable for patients who present with moderate to severe ischemic stroke and demonstrate early improvement but remain moderately impaired and potentially disabled in the judgment of the examiner. IIA
Wake-up strokes: DAWN and DEFUSE 3
AHA/ASA Patients with a positive stroke screen and/or a strong suspicion of stroke should be transported rapidly to the closest healthcare facilities that can capably administer IV alteplase.
Large vessel occlusion, 6 hours Refer for possible thrombectomy
These are not decisions to be made on shift