Vaskulárna medicína 2-3/2018
Changes in the paradigme of treatment of ischemic stroke
According to current recomendations and standards of care, acute treatment of ischemic stroke is currently limited to 4,5 hours (for intravenous thrombolysis) or 6 hours (for mechanical recanalization) since time of onset. This „arbitrary“ period is set as acceptable for effect and safety of urgent treatment. However, the same period rules out of acute treatment large number of stroke patients with uncertain, unknown or disputable time of onset. In recent years, numbe of studies evaluates effect of urgent treatment according to brain imaging – CT or MR perfusion – as a marker of potential benefit between irreversible brain damage and brain regions with potential of salvation by urgent treatment. Our institution uses automated brain perfusion imaging, confirmed as highly relevant by DAWN and DEFUSE-3 studies, to identify patients with potential of reperfusion therapy in 6-24 hours time slot. Our paper summarizes recent knowledge and brings our own data and case reports.
Keywords: ischemic stroke, reperfusion therapy, mechanical thrombectomy, neuroimaging, patients triage
