1. Advances in Treatment for Acute Stroke
Dr. Syed Zaidi

2. Fast Assessment TIME IS BRAIN
Recognize stroke symptoms: acute change in balance, visual symptoms, speech difficulty, facial asymmetry, extremity weakness
Contact 911/ First Responders. Be transported to a local hospital equipped to handle acute stroke patients

3. Treatment for Stroke Patients
TPA: tissue plasminogen activator- Clot Buster
Approved by the FDA in 1996
Must be given within hours of stroke symptom onset or Last Known Well
The sooner this drug is given, the better the results
Must be evaluated to be a candidate. There is certain criteria used to include or exclude a patient from being a TPA candidate

4. TPA: Clot Buster

5. Some Exclusion Criteria for TPA
Unclear when symptoms started
Anticoagulant Use- strong blood thinners like Coumadin, Pradaxa, Eliquis, Xarelto
Recent major surgery or trauma
The EC staff or stroke neurologist will review your history to determine if you are a candidate

6. WHAT TO DO NOW !!! There’s an absolute tPA contraindication
Patient is outside the window for tPA
tPA is not working
WHAT TO DO NOW !!!

7. A New Standard of Care- the role of endovascular treatment
Five recent medical studies closely looked at the role of endovascular treatment for acute stroke patients
It was discovered that TPA may not be sufficient in patients that have larger clots in their main larger intracranial vessels and they may require an endovascular intervention to remove the clot
There are certified stroke centers like Toledo Hospital that have specially trained neuro-interventional physicians who can perform this procedure emergently for stroke patients.

8. Endovascular Treatment
Acute ischemic stroke patients are screened through clinical exam and sometimes imaging to see if they have a large vessel occlusion
Screening includes a National Institute of Health Stroke Assessment (clinical exam)
Radiology studies. Every stroke patient needs to have a noncontrast CT Brain
Possible additional studies such as specialized CT or MRI scans may be performed

9. The Lab: Cerebral angiography
This study is done in a specialized neuro suite where pictures are obtained hoping to identify an area of occlusion

10. 53 yo with aphasia and right sided paralysis – Pre Thrombectomy Run

11. Mechanical Embolectomy

12. Final angiographic run

13. Hemorrhagic stroke

14. A Few Causes of Hemorrhagic stroke
Aneurysm Rupture or other vessel abnormalities
Uncontrolled High Blood Pressure (Hypertension)
Amyloid Angiopathy- protein build up in the brain. Often associated with dementia
Brain Tumors
Substance Abuse (Cocaine)

15. Management of Hemorrhagic Stroke
Subarachnoid Hemorrhages need to be evaluated by cerebral angiography to see if the bleed is related to an aneurysm (weakness of the blood vessel) that ruptured. Treatment can be endovascular or an open brain surgery
Intraparenchymal bleeds can sometimes be managed without surgery. In some cases with larger bleeds though, surgical evacuation may be necessary.

16. Subarachnoid Hemorrhage
Medical Emergency
Often related to cerebral aneurysm rupture
Requires a higher level of care with Neurosurgical and Neuro-interventional capabilities

17. Neurointerventional Suite
Treatment of cerebral aneurysm with platinum coils

18. Intraparenchymal Bleed

19. Intraparenchymal Bleed
Majority of the time can be managed without surgery
Often required aggressive blood pressure control and monitoring in an ICU setting
Neurosurgeon should be available if there is any change in case surgery is warranted.

20. Questions??