Faster treatments, better outcomes: 5 key takeaways from new stroke guideline

 What a pile of shit; GUIDELINES NOT RECOVERY PROTOCOLS! You're all fired for incompetence! Until we get survivors in charge nothing will occur towards 100% recovery protocols! Once again proving that the ASA is one of those fucking failures of stroke associations!

Faster treatments, better outcomes: 5 key takeaways from new stroke guideline

The American Stroke Association (ASA), a division of the American Heart Association, has developed an updated ischemic stroke guideline that highlights the importance of coordinated care and expands patient access to critical treatments. The new document, published in full in Stroke, also includes the first detailed recommendations for treating stroke in pediatric patients.[1]

“This update brings the most important advances in stroke care from the last decade directly into practice,” Shyam Prabhakaran, MD, MS, chair of the writing group behind the guideline and chair of the department of neurology at the University of Chicago Medicine, said in a statement. “New recommendations in the guideline expand access to cutting-edge treatments, such as clot-removal procedures and medications, simplify imaging requirements so more hospitals can act quickly, and introduce guidance for pediatric stroke for the first time.”

These represent just some of the biggest highlights from the new guidance:

1. Coordinated care saves lives

When hospitals, call centers, emergency medical services (EMS) agencies and telemedicine networks are all on the same page, the result is a strong healthcare system that gets patients the care they need as quickly as possible. It is no secret that “time is brain” when it comes to treating stroke patients—the earlier patients receive attention from medical professionals, the better.

For example, patients with a suspected large vessel occlusion (LVO) should be sent to the nearest thrombectomy-capable stroke center if one is available. This minimizes the risk of delayed care and ensures an expert care team will be able to quickly perform endovascular thrombectomy (EVT) when necessary.

2. Imaging remains an essential piece of the puzzle

As always, medical imaging plays a critical role in the diagnosis and treatment of ischemic stroke. Mobile stroke units are equipped with CT scanners to get an immediate visual of the patient, for example, and advanced imaging techniques continue to evolve in ways that are speeding up the entire care process. 

The recommendations note that patients should undergo an initial brain scans within 25 minutes of arriving at the hospital. This helps the team know what exactly is causing the patient’s symptoms.  It is also necessary to determine if a stroke is hemorrhagic or ischemic, because this determines which medications and/or procedures may be necessary.

3. Clot-busting medications make a world of difference

The updated guideline endorses the use of tenecteplase or alteplase within 4.5 hours of symptoms onset—and they are sometimes recommended for as much as 24 hours after symptoms first make themselves known. These drugs have been used for years now to dissolve blood clots, and single-dose IV infusions of tenecteplase are proving to be especially impactful in improving patient care.

(But don't you even acknowledge they are a failure that only works toward 100% recovery 12% of the time!)

4. Endovascular thrombectomy grows in importance

EVT, a procedure that involves removing blood clots from blocked brain arteries, is now recommended for up to 24 hours after symptom onset in certain patient populations. Many patients may require both clot-busting medications and EVT.

EVT is also showing more and more value as a treatment option for posterior circulation stroke. The procedure is typically not used for smaller blockages, according to the guideline, but such a strategy may be considered for a clinical trial.

5. Pediatric stroke finally in the spotlight

For the first time, the ASA has shared detailed recommendations for the treatment of pediatric stroke patients in their industry guideline.

Children may exhibit the same stroke warnings signs seen in adults—faces dropping, speech difficulty—but they also show different symptoms, including severe headaches, difficulty walking and seizures, typically only on one side of the body. The ASA also pushed care teams to use MRI scans and angiography right away to identify any potential blockages and help obtain a rapid diagnosis. CT scans may be required if MRI scans are not readily available.

When pediatric patients need treatment, IV infusions of alteplase can be administered within 4.5 hours of symptom onset in patients between the ages of 28 days and 18 years old. Experienced neurointerventionalists can also be brought in to perform treatment on patients between the ages of 6 years old and older. 

However, the writing group noted, researchers are still working to learn more about this topic.

“These recommendations represent a major step toward standardized, evidence-based care for children,” Prabhakaran said in the same statement. “They also highlight how much more we still need to learn about pediatric stroke.”

Click here to review the full guideline.