Stent retriever thrombectomy is the recommended standard of care for patients suffering acute ischemic stroke (AIS), the most common type of stroke.1 Ischemic stroke occurs when blood vessels carrying oxygen and nutrients to the brain are blocked by a clot, causing brain cells to die.
The 2015 update to the AHA/ASA guidelines for early management of patients with AIS now recommends the use of endovascular treatment with stent retrievers, following IV t-PA, for eligible patients.1
Large vessel occlusions (LVO), in particular, respond poorly to IV t-PA.2-3
The typical AIS patient loses 2 million neurons/min in the territory at risk7 but ischemic penumbra can be salvaged if the vessel is quickly recanalized.8
Successful recanalization is associated with:
A good prehospital assessment and routing system is imperative to improving patient outcomes and includes:
Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. Oct 2015;46(10):3020-3035.
Del Zoppo et al. Ann Neurol 1992.
Bhatia et al. Stroke. 2010; 41: 2254-2258.
Saqqur et al., Stroke, 2007. 38: 948-954.
Smith et al. Stroke. 2009. 40: 3834-3840.
Smith et al. Neurocritical Care. 2006. 4: 14-17.
Saver JL et al. Stroke. 2006; 37:263-266.
Rha et al. Stroke. 2007. Mar; 38(3): 967-73.
Powers et al. Stroke. 2015; 46:3020-3035.
Kothari RU, Pancioli A, Liu T, Brott T, Broderick J. “Cincinnati Prehospital Stroke Scale: reproducibility and validity.” Ann Emerg Med 1999 Apr; 33(4):373-8.
Kidwell CS, Starkman S, Eckstein M, Weems K, Saver JL. “Identifying stroke in the field. Prospective validation of the Los Angeles prehospital stroke screen (LAPSS).” Stroke 2000 Jan; 31(1):71-6.
Llanes JN, Kidwell CS, Starkman S, Leary MC, Eckstein M, Saver JL. The Los Angeles Motor Scale (LAMS): a new measure to characterize stroke severity in the field. Prehospital emergency care: official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. Jan-Mar 2004; 8(1):46-50.
Perez de la Ossa N, Carrera D, Gorchs M, et al. Design and validation of a prehospital stroke scale to predict large arterial occlusion: the rapid arterial occlusion evaluation scale. Stroke; a journal of cerebral circulation. Jan 2014; 45(1):87-91.