MD Conference Express ISC 2013 - (Page 8)

FEATURE Defending the Stroke Guidelines Written by Phil Vinall At this year’s International Stroke Conference, leaders in the field of stroke met to review some of the important updates to stroke-related guidelines. Edward C. Jauch, MD, MS, Medical University of South Carolina, Charleston, South Carolina, USA, discussed some of the important revisions to the Guidelines for the Early Management of Patients With Acute Ischemic Stroke [Jauch EC et al. Stroke 2013]. Key areas of focus include the importance of stroke systems of care, streamlining processes to minimize time, the importance of reperfusion (intravenous [IV] and intra-arterial), and expanded eligibility for reperfusion. The revised guidelines state that “patients should be transported rapidly to the closest available certified primary stroke center or comprehensive stroke center…” and they stress the importance of emergency medical services in prehospital notification. There are revised guidelines on emergency evaluation and diagnosis of stroke, particularly with respect to testing prior to initiation of IV tissue plasminogen activator (tPA) and the use optimal use of imaging. Revised recommendations for IV fibrinolysis now call for a door-to-needle time that is within 60 minutes from hospital arrival. There are several revised recommendations concerning eligibility criteria for the use of tPA, and there are new recommendations addressing endovascular interventions. Alejandro Rabinstein, MD, Mayo Clinic, Rochester, Minnesota, USA, reviewed the highlights from the 2012 Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (aSAH) [Connolly ES et al. Stroke 2012] in the following areas: Risk Factors and Prevention ■ Improved guidance for the treatment of hypertension (HTN). Natural History and Outcome ■ Determine severity early using Hunt-Hess or World Federation Neurosurgeons Scale. Peer-Reviewed Highlights From ■ Evaluate and treat suspected aSAH as soon as possible to reduce the risk of rebleeding. ■ Introduce multidisciplinary and comprehensive follow-up. Diagnosis and Clinical Presentation ■ Computed tomography angiography may be considered, but, if inconclusive, use digital subtraction angiography (DSA). ■ Magnetic resonance imaging can be considered for emergency diagnosis if CT is nondiagnostic, but it does not obviate the need for a lumbar puncture. ■ DSA with 3D rotational images is indicated before deciding on a treatment approach. Medical Measures to Prevent Rebleeding ■ Control HTN with a titratable agent (decreasing systolic blood pressure to <160 mm Hg is reasonable). ■ If treatment is delayed and there are no compelling contraindications, short-term (<72 hours) treatment with tranexamic acid or aminocaprioic acid is reasonable. ■ Coiling should be considered for aneurysms that are amenable to both coiling and clipping. Vasospasm ■ Oral nimodipine is recommended. ■ Maintain euvolemia and normal circulating volume to prevent delayed cerebral ischemia (DCI). 8 April 2013 www.mdconferencexpress.com  http://www.strokeconference.org http://www.mdconferencexpress.com

Table of Contents for the Digital Edition of MD Conference Express ISC 2013

MD Conference Express ISC 2013
Contents
Defending the Stroke Guidelines
Stroke Update: An Overview of What Is Going on in the Area of Stroke
Brain Imaging Does Not Help Identify Patients Who May Benefit From Endovascular Treatments for Acute Ischemic Stroke
MISTIE II Trial: 365-Day Results Demonstrate Improved Outcomes and Cost Benefit
Addition of AMPLATZER PFO Occluder to Medical Therapy Is Beneficial in Patients With Cryptogenic Stroke and PFO
Intraoperative CT-Guided Endoscopic Surgery for ICH [ICES]
The EMBRACE Trial: Prolonged Ambulatory Cardiac Monitoring Improves the Detection and Treatment of Atrial Fibrillation in Patients With Cryptogenic Stroke
DP-b99 Does Not Improve Recovery Following Acute Ischemic Stroke
The Secondary Prevention of Small Subcortical Strokes Trial: Blood Pressure Intervention Results
Final Results of the Solitaire FR Thrombectomy for Acute Revascularization: The STAR Trial
Clopidogrel Plus Aspirin Reduces Risk of Recurrent Stroke: The CHANCE Trial
Reversal of Chronic Hypoperfusion to Improve Cognitive Function: The RECON Trial
Cardioembolic Stroke
IMS III
Novel Anticoagulants in Vascular Neurology Practice
Wake-Up Stroke
Virtual Reality in Stroke Rehabilitation
Reward Improves Long-Term Retention of a Motor Memory Through Induction of Offline Memory Gains

MD Conference Express ISC 2013

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