University of Bologna, Italy Chair of Neuroradiology

Slides:

Advertisements

Similar presentations

Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times Michael D. Hill.

Advertisements

Accomplishments in Stroke Care

TPA in Stroke: What's All the Fuss?. FERNE Brain Illness and Injury Course.

Some Difficult Stroke Cases: What Would You Do?

Advanced Treatment Options for Stroke Patients Vickie Gordon PhD, ACNP-BC, CNRN.

Target: Stroke Building on Success A national quality improvement initiative of the American Heart Association/American Stroke Association to improve.

Dr Amer Jafar. Early Dementia After First-Ever Stroke From 1985 to 2008, overall first-ever strokes occurring within the population of the city of Dijon,

ESCAPE Protocol Slides. What is the clinical question? Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis.

Brain Single-Photon Emission CT With HMPAO and Safety of Thrombolytic Therapy in Acute Ischemic Stroke Proceedings of the Meeting of the SPECT Safe Thrombolysis.

What neurologist may add to the care and cure of of stroke patients, or… Peter Sandercock Perugia December 2007 What is the place of the neurologist in.

Blood Pressure Reduction Among Acute Stroke Patients A Randomized Controlled Clinical Trial Jiang He, Yonghong Zhang, Tan Xu, Weijun Tong, Shaoyan Zhang,

Clinical diagnosis in the acute phase of stroke – quite a challenge! Peter Sandercock Edinburgh.

Neuroimaging of Ischemic Stroke With CT and MRI

T-PA in Treatment of Acute Stroke: What We Know From NINDS 2004 vs 2000 Sidney Starkman, MD Departments of Emergency Medicine and Neurology, UCLA UCLA.

 Describe the major signs and symptoms of stroke  Classify stroke and type specific treatments  Apply 8 d’s of stroke care  Follow suspected stroke.

Acute ischemic stroke: Not a moment to lose By Julie Miller, RN, CCRN, BSN, & Janice Mink, RN, CCRN, CNRN Nursing2009, May ANCC contact hours.

Interventional Stroke Treatment 2015

Endarterectomy versus Stenting in Patients with Symptomatic Severe Carotid Stenosis Dr. Quan, Dr. Mirhashemi, Dr. Chiang N Engl J Med 2006; 355:

Interventions in Acute Ischemic Stroke: Strategies for the New Millennium For the next 25 minutes, we will spend sometime talking about Neuroimaging.

TELEMEDICINE AND RESEARCH. THE TELEICTUS PROJECT IN THE HOSPITAL St JOHN OF GOD´S OF ALJARAFE. Antonio Fernández Moyano MD. PhD. Internal Medicine Service.

The Evolving Management of Pediatric Stroke Christopher A. Miller, MD July 21, 2012.

10 May 2005 CASES - Original article available at CASES (Canadian Alteplase for Stroke Effectiveness Study) The CASES Investigators.

What’s on the horizon? Peter Sandercock ESC Lisbon 23rd May 2012.

Thrombolysis in acute ischaemic stroke – Updated Cochrane Thrombolysis metaanalysis JM Wardlaw, V Murray, PAG Sandercock University of Edinburgh and Karolinska.

Tissue Plasminogen Activator for Acute Ischemic Stroke National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.

Evidence in the ED Byron Drumheller, MD Penn Emergency Medicine.

Overview of new acute stroke trials Shawna Cutting, MD, MS Rush University Medical Center June 9, 2015.

Intra - Arterial Thrombolysis for acute stroke

N EURORADIOLOGY. S TROKE ISCHEMICHEMORRHAGIC N ontraumatic intracranial hemorrhage HYPERTENSION RUPTURE ANEURYSM VASCULAR MALFORMATIONS COAGULOPATHY.

Delayed Posttraumatic Hemorrhage From (Stroke. 1995;26: ) © 1995 American Heart Association, Inc. Present by R2 Meng-Ting Wu.

Recognition and Treatment of Large MCA Strokes Matthew S. Smith, MD, MS Director of Neurocritical Care Assistant Professor of Neurology Assistant Professor.

Long-term clinical outcome following emergency MR-based reperfusion therapy for acute middle cerebral artery occlusion Department of Stroke Treatment,

Intervention in Stroke- Intra-arterial thrombolyis and Mechanical thrombectomy Dr Sanjeev Nayak Consultant Neuroradiologist.

before thrombolysis in acute stroke

A multimodal step-up approach as rescue therapy of ischemic stroke L. Verganti, S. Vallone, C. Moratti, M. Malagoli, P. Carpeggiani Department of Neuroscience,

Long-Term Clinical Outcome After Emergency MR-based Reperfusion Therapy for Acute Basilar Artery Occlusion Department of Stroke Treatment, Shonan Kamakura.

Kim, Sun-Yong, M.D. Department of Radiology Ajou University Hospital, Suwon, Korea AGGRESIVE MECHANICAL CLOT DISRUPTION FOR ACUTE ISCHEMIC STROKE WITH.

MR CLEAN Multicenter Randomized CLinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands C.B. Majoie, Y.B. Roos, A. van der.

New ways of imaging Stroke/TIA Dr Suzanne O’Leary Neuroradiology SpR Frenchay Hospital.

ACUTE STROKE TREATMENT: An introduction Dec.2014

Dr Marc Randall Consultant Neurologist and Stroke Physician Honorary Senior Lecturer University Sheffield.

Dr. Quan, Dr. Mirhashemi, Dr. Chiang

Treating Acute Ischemic Stroke, Can We Open Up the Time Window？

ACUTE ISCHEMIC STROKE Olajide Williams, MD MS.

Acute Stroke Management

Table 1: Table 2: Non Therapeutic Angiograms in Acute Ischemic Stroke Patients Being Considered for Endovascular Treatment Does not Adversely Affect Patient.

Iwata T, Mori T, Tajiri H, Uesugi T, Nakazaki M

From: Intra-arterial Prourokinase for Acute Ischemic StrokeThe PROACT II Study: A Randomized Controlled Trial JAMA. 1999;282(21): doi: /jama

Direct catheter-based thrombectomy in acute ischemic stroke

PATIENT CASE REPORT Acute Ischemic Stroke Follow-up

Thrombectomy in Acute Stroke

Clinical Audit of Head CT in Stroke Alert Cases: Role of Radiology Resident and CT Technologist Awareness in improving Head CT reporting time K Hooda,

Acute Stroke Therapy with IV Thrombolysis Lawrence R. Wechsler, M.D.

First Stroke Unit in Al Ain: Five Years Experience

CAS in acute stroke C. Roth‡, P. Papanagiotou‡, A. M. Politi‡, K. W. Reith‡ Department of diagnostic.

Cerebrovasc Dis 2014;37: DOI: /

Cardiovascular Research Technology Conference (CRT 17)

Haris Kamal, MD; Ashkan Mowla, MD,FAHA ; Navdeep S

When Not to Intervene in Acute Stroke or

This program will include a discussion of off-label treatment and investigational agents not approved by the FDA for use in the United States, and data.

Patient Education Public education must involve all age groups. Incorporating stroke into basic life support (BLS) and cardiopulmonary resuscitation (CPR)

Modified Rankin score 0-2

The Role of Induced Hypertension and Hyperbaric Oxygen Therapy in Moyamoya Disease: A Case Report Smeer Salam, MD; Lisa Pabst, MD; Sushil Lakhani, MD;

Extended Window Thrombectomy

Update from education committee

Carotid Stenting in Acute Ischemic Stroke Resulting from Tandem Occlusions STEWART WEBER, MD.

Update from education committee

Jennifer E. Fugate, DO, Alejandro A. Rabinstein, MD

Suggested imaging protocols for patients presenting with acute stroke symptoms based on the clinical scenario and the therapeutic options considered and.

Presentation transcript:

University of Bologna, Italy Chair of Neuroradiology Prof. Marco Leonardi University of Bologna, Italy Chair of Neuroradiology Bellaria Hospital www.neuroradiologia.unibo.it Dr Luigi Simonetti

Relation between Site of Occlusion and Outcome of Intravenous Thrombolysis in a Cohort of Patients Studied with CT Angiography C. Barbara, A. Stafa, G. Procaccianti, L. Simonetti, M. Leonardi

From the beginning… Few slides about our “modus operandi” in acute stroke.

Intra-hospital Step When a patient is considered to be eligible for the trombolitic treatment, the dedicated “trombolysis team” will be alerted with “Stroke Yellow Code”

The principal inclusion criteria for the trombolysis: Both sex patients, age range 18-80 years Ischemic stroke generating an acute neurological deficit Starting symptoms: < 3 hours Brain CT excluding intracranial haemorrhage ASPECT Score: > 7

When we perform CTA of supra-aortic vessels & intracranial circulation? Always, if the patient is eligible for IV or IA trombolysis

TROMBOLYSIS: april 2008-september 2010

- 240 pts (ab 50%) excluded during ER evaluation, before CT scan starting symptoms: >3h before, or time not definable (stroke presumably in asleep patient): 54 Age > 80 5 mild neurological deficit 51 TIA 46 deep coma 23 dismetabolic coexisting diseas 20 epileptic seizures 18 psychiatrical clinical back-ground 8 other 15

- 95 pts (20%) excluded after CT-CTA scan intracranial hemorrhage 67 extracranial ICA occlusion 15 ASPECT score < 8 13 10 pts (their relatives) refused therapy

Overall Results Δ NIHSS 24 h: 5.0

T-shaped occlusion (15 pts) Δ NIHSS 24 h : -2

BM, 33 aa Left Hemiparesis

M1 occlusion (31 pts) Δ NIHSS 24 h: 3.9

“Mild” M1 occlusion

CR, F 58 aa Left hemiplegia 190’ aftert presuming start od symptoms CR, F 58 aa Left hemiplegia 190’ aftert presuming start od symptoms. IV rTPA

“Severe” M1 occlusion

BMP, 59 aa right hemiplegia 3h 20’ after presuming start of symptoms

Δ NIHSS 24 h: 9

M2 occlusion (39 pts) Δ NIHSS 24 h: 6.2

TL, 68 aa Left hemiplegia 3h 40’after presuming start of symptoms, IV rTPA

Distal branch occlusion (53 pts) Δ NIHSS 24 h: 6.5

TM, 62 aa Right hemiparesis and afasia

Admission brain CT

Admission CTA

36 h CT

TROMBOLYSIS H. Maggiore April 2008 – september 2010 Overall Outcome on 138 pts: Rankin Scale % 32 1-2 26 3 5 4-5 33 6 4 TOTAL 100

On the base of these CTA data In accord (+/-) with our neurologists

Three protocols that our Ethical Committee approved on July 2010 Pts with “mild” M1 occlusion: Synthesis Expansion randomization Pts with M2 or distal occlusion: IV, eventually ”bridging therapy” Pts with “T shaped” occlusion or “severe” occlusion in M1: “Opus” experimental study (intra-arterial thrombolysis by UV laser)

Some conclusive considerations The role of the diagnostical and therapeutical neuroradiology is fully recognized and formalized The intra-venous trombolysis? It works. The CT-Angio, performed in every case as a standard step of the protocol, represents an important tool for the definition of the prognosis and, potentially, for the definition of the therapeutical choice.

Thank you for the kind attention