Mechanical thrombectomy, IV alteplase recommendations updated in new stroke guidelines

You lazy fucking assholes, 'Guidelines' NOT protocols. Can you get any lazier? And you expect to get paid for this crapola?
https://www.healio.com/cardiology/stroke/news/online/%7B8f38493a-36ce-4832-8ef7-5e382f55d24b%7D/mechanical-thrombectomy-iv-alteplase-recommendations-updated-in-new-stroke-guidelines?utm_source=selligent&utm_medium=email&utm_campaign=cardiology%20news&m_bt=592835816269

January 24, 2018

William J. Powers

IV alteplase may benefit patients with mild strokes, and mechanical thrombectomy may be performed up to 16 hours after the onset of an acute ischemic stroke, according to newly released guidelines published by the American Heart Association and American Stroke Association in Stroke.
“The purpose of these guidelines is very broad,” William J. Powers, MD, FAHA, department chair of stroke and vascular neurology and H. Houston Merritt distinguished professor at University of North Carolina at Chapel Hill and chair of the guidelines writing group, said during a press conference. “They’re not just for physicians. They’re for any health care provider who cares for patients with acute ischemic stroke.”

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In-hospital treatment
According to the guidelines, regional systems of stroke care should be created and include health care facilities for initial emergency care and centers that can perform endovascular stroke treatment. This remains unchanged from the 2015 endovascular guidelines.
Leaders of emergency medical services should develop triage protocols and paradigms to identify and assess patients with a known or suspected stroke. Screening should be done with instruments such as the Los Angeles Prehospital Stroke Screen, FAST scale or Cincinnati Prehospital Stroke Scale.
“We want the patients who do have stroke to get to the hospital as fast as possible,” Powers said. “This means some kind of screening in the field by emergency medical services and ... they need to go to the closest hospital that can adequately evaluate them and give them intravenous [tissue plasminogen activator] or alteplase if they are eligible for it.”
Patients should receive mechanical thrombectomy with a stent retriever if they are aged at least 18 years, have a pre-stroke modified Rankin scale between 0 and 1, have a NIH Stroke Scale score of 6 or greater, have causative occlusion of the internal carotid artery or middle cerebral artery segment 1, have an ASPECTS score of at least 6 and if treatment can start within 6 hours of symptom onset. The guidelines now include those who are ineligible for IV alteplase (Activase, Genentech), as they may benefit from this treatment.
A previous guideline restricted use of mechanical thrombectomy to within 6 hours of ischemic stroke onset, but the new guidelines expand the time window for use depending on certain criteria.
Mechanical thrombectomy is recommended for patients with acute ischemic stroke with large vessel occlusion in the anterior circulation within 6 to 16 hours of symptom onset and who meet DEFUSE-3 or DAWN trial eligibility criteria. It is reasonable for patients to receive this treatment within 16 to 24 hours if they meet other DAWN eligibility criteria.

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