Acute stroke treatment: without time limitations



Since last forever, much to my chagrin, the concept of TIME IS BRAIN has lingered on and hampered the treatment of stroke patients. From the year 1 of my neuroradioogy, i.e my training days, I believed the insufficiencies hidden in this concept but no one believes me. Now however, concepts are improving and even nonradiologists are understanding the benefits of advanced noninvasive imaging. Proof is the multitude of papers published on the usage of perfusion imaging to assess for suitability of treatment of acute stroke.
Now perfusion imaging is being taken to the next level and applied to patients with acute stroke > 6 hours, patients which earlier were destined to live and die with 'aspirin' and 'heparin' nad not get the benefit of aggressive management.
Turk et al have orated an abstract in the SNIS annual meet where they used perfusion imaging in patients beyond 6 hours and patients under 6 hours and found no difference in outcome.
Go through the article and enlighten. Yipee!

J NeuroIntervent Surg 2010;2:A1 doi:10.1136/jnis.2010.003244.2
  • SNIS 7th Annual Meeting
  • Oral abstract

Acute stroke treatment: without time limitations

Medical University of South Carolina, Charleston, South Carolina, USA

Abstract

Background Many new stroke trials are evaluating the utility of perfusion imaging for patient selection within certain time constraints. There is evidence that patients with a delayed (>12 h) clinical–diffusion mismatch have poor clinical outcomes. We present our experience utilizing perfusion imaging to triage patients for endovascular therapy irrespective of time constraints.
Methods 53 patients were treated over the past 2 years utilizing presenting National Institutes of Health Stroke Scale (NIHSS), anatomic imaging and perfusion information. Patients were excluded if they had a hemorrhage or significant completed stroke (>1/3 middle cerebral artery territory volume) on CT or cerebral blood volume maps. If perfusion imaging was limited, as in some basilar occlusion cases, then the clinical examination (NIHSS) was used. The median time to treatment from symptom onset of the patient cohort was then determined and patients were divided into two groups. Clinical outcomes were then documented and subgroup analysis was performed.
Results The mean time to treatment was 10.36 h and the median was 6.13 h (range 1.75–72 h), suggesting several patients were treated far beyond 6 h. Utilizing a 6 h time point to identify two separate groups yielded 26 patients treated before 6 h and 27 patients treated more than 6 h from symptom onset. Angiographically, TIMI2 or better flow was restored 96% of the time. Patient outcomes in those treated less than 6 h compared with more than 6 h showed modified Rankin Score (mRS) of 0–2 in 36% and 37%, respectively, and mRS 0–3 in 56% and 52%, respectively.
Conclusion Utilization of perfusion based techniques is a viable clinical strategy for identifying acute stroke patients for endovascular therapy. Clinical outcomes can be obtained that are similar to those of clinical trials, irrespective of time constraints in appropriately selected patients.




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