Stroke; a journal of cerebral circulation
-
Three recently published trials have conclusively proven the benefit of mechanical endovascular thrombectomy over best medical therapy for patients with acute ischemic stroke and large vessel occlusion. These trials shared some features and differed in others. ⋯ We will examine the implications of these studies for neurointerventionists, both for current practice and for future studies. In particular, we will focus on procedural details such as patient selection, devices, adjunctive therapies, treatment time windows, and performance metrics.
-
Timely recanalization leads to improved patient outcomes in acute ischemic stroke. Recent trial results demonstrated a strong benefit for endovascular therapies over standard medical care in patients with acute ischemic stroke and a major intracranial artery occlusion≤6 hours or even beyond from symptom onset and independent of patients' age. Previous studies have shown the benefit of intravenous thrombolysis that had gradually, albeit slowly, reshaped acute stroke care worldwide. ⋯ Europe-wide new training programs for expert physicians in stroke care should be initiated shortly. European Stroke Organisation has a unique role in providing expertise, consultation, guidelines, and versatile training in meeting new demands in stroke care. This article discusses the current situation, prospects, and challenges in Europe offering personal views on potential solutions.
-
Observational Study
Clinical predictors of accurate prehospital stroke recognition.
Prehospital activation of in-hospital stroke response hastens treatment but depends on accurate emergency medical services (EMS) stroke recognition. We sought to measure EMS stroke recognition accuracy and identify clinical factors associated with correct stroke identification. ⋯ EMS providers recognized 3 quarters of the patients with ischemic stroke and transient ischemic attack; however, half of EMS-suspected strokes were false positives. Documentation of a Cincinnati Prehospital Stroke Scale was associated with higher EMS stroke recognition sensitivity and PPV.