Great question! To maximize outcomes, there is a whole orchestrated process to quickly evaluate and treat stroke patients. That begins on the arrival to the emergency department or, if in house, a nurse or doctor suspects the patient is demonstrating stroke like symptoms. A hospital-wide announcement is made over the PA system of a “Stroke Alert” which mobilizes the stroke team consisting of the on-call neurologist, stroke coordinator and ancillary staff. A quick physical exam confirms if the patient’s symptoms are stroke-like and which side of the brain is likely affected. While this is happening, someone from the stroke team is interviewing family or friends to determine what time the patient was last seen normal. If symptoms began within 3 hours of arrival, patient is still a candidate for IV-TPA. CT scan of the brain is performed and immediately interpreted. If there is no bleed and patient is within the 3 hour window, TPA is started in the CT room. Simultaneously, the radiology team is preparing the patient for a CTA (CT angiogram) of the neck and head vessels, a 3D post contrasted CT exam which can show the size and location of any clot/embolus. Patient may also receive a CT perfusion scan depending on the clinical circumstances. If patient is not improving on TPA after a few minutes or they are outside the acceptable window for IV-TPA but still within the window for catheter directed embolectomy (6-24 hours), the patient is transported to the angio suite for intervention. The goal is to get to any necessary catheter directed intervention with 60 minutes of the patients arrival. In some centers, new software called ‘RAPID’ can look at the post-contrasted CT or MR perfusion data and accurately predict if there is salvage brain in patients outside the normal time windows or with unwitnessed events- what we call “wake-up strokes.”
Thankyou sir....
How does a comprehensive centre know when tPa isn’t enough on its own and an interventional procedure is needed?
Great question! To maximize outcomes, there is a whole orchestrated process to quickly evaluate and treat stroke patients. That begins on the arrival to the emergency department or, if in house, a nurse or doctor suspects the patient is demonstrating stroke like symptoms. A hospital-wide announcement is made over the PA system of a “Stroke Alert” which mobilizes the stroke team consisting of the on-call neurologist, stroke coordinator and ancillary staff. A quick physical exam confirms if the patient’s symptoms are stroke-like and which side of the brain is likely affected. While this is happening, someone from the stroke team is interviewing family or friends to determine what time the patient was last seen normal. If symptoms began within 3 hours of arrival, patient is still a candidate for IV-TPA.
CT scan of the brain is performed and immediately interpreted. If there is no bleed and patient is within the 3 hour window, TPA is started in the CT room. Simultaneously, the radiology team is preparing the patient for a CTA (CT angiogram) of the neck and head vessels, a 3D post contrasted CT exam which can show the size and location of any clot/embolus. Patient may also receive a CT perfusion scan depending on the clinical circumstances.
If patient is not improving on TPA after a few minutes or they are outside the acceptable window for IV-TPA but still within the window for catheter directed embolectomy (6-24 hours), the patient is transported to the angio suite for intervention. The goal is to get to any necessary catheter directed intervention with 60 minutes of the patients arrival.
In some centers, new software called ‘RAPID’ can look at the post-contrasted CT or MR perfusion data and accurately predict if there is salvage brain in patients outside the normal time windows or with unwitnessed events- what we call “wake-up strokes.”