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. 2019 Dec;6(4):273-287.
doi: 10.15441/ceem.18.065. Epub 2019 Dec 31.

Emergency management of stroke in the era of mechanical thrombectomy

Ethan S Brandler  1 , Nayeem Baksh  1
Affiliations

Emergency management of stroke in the era of mechanical thrombectomy

Ethan S Brandler et al. Clin Exp Emerg Med. 2019 Dec.

Abstract

Emergency management of stroke has been directed at the delivery of recombinant tissue plasminogen activator (tPA) in a timely fashion. Because of the many limitations attached to the delivery of tPA and the perceived benefits accrued to tPA, its use has been limited. Mechanical thrombectomy, a far superior therapy for the largest and most disabling strokes, large vessel occlusions (LVOs), has changed the way acute strokes are managed. Aside from the rush to deliver tPA, there is now a need to identify LVO and refer those patients with LVO to physicians and facilities capable of delivering urgent thrombectomy. Other parts of emergency department management of stroke are directed at identifying and mitigating risk factors for future strokes and at preventing further damage from occurring. We review here the most recent literature supporting these advances in stroke care and present a framework for understanding the role that emergency physicians play in acute stroke care.

Keywords: Emergencies; Large vessel occlusion; Mechanical thrombectomy; Stroke; Tissue plasminogen activator.

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Conflict of interest statement

Ethan S. Brandler is supported by the Northeast Cerebrovascular Consortium for his research in prehospital stroke care. Except for that, no potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Critical pathway for emergency medical service (EMS) management of suspected stroke.
Fig. 2.
Fig. 2.. Emergency Department Clinical Pathway.
EMS, emergency medical system; CT, computed tomography; LVO, large vessel occlusion; NIHSS, National Institutes of Health Stroke Scale; BP, blood pressure; tPA, tissue plasminogen activator.
See this image and copyright information in PMC

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