• ED Treatment of Acute Ischemic Strokes: The Future of the Brain Cath Lab

      Crider, Allie; Bedoya, Damien (2021)
      Acute ischemic strokes are defined as a sudden cessation of blood flow to an area of the brain, resulting in hypoxic death of brain tissue and subsequent loss of neurologic function. They are a leading cause of serious disability worldwide and cost the US healthcare system roughly $3.2 billion per year.1 Historically, first-line treatment for acute ischemic strokes has been thrombolytic therapy with Tissue-Type Plasminogen Activation (tPA), which works by systemically altering the blood�s clotting cascade. tPA is a very effective therapy, however, it carries with it a significant risk of life-threatening bleeding events. Because of the wide array of contraindications to tPA, many patients with prior history of bleeding, anticoagulation use, or prolonged presentation of symptoms are ineligible for this therapy. Mechanical thrombectomy (MT) is an alternative treatment which involves placing catheter-guided stents directly at the site of intravascular blockages in the brain. This method has primarily been reserved for patients in which systemic anticoagulation is contraindicated and was considered a second-line treatment for years. During the early 2010�s, several studies supported the consideration of mechanical thrombectomy as an additional first-line treatment choice in certain patient populations, rather than strictly as an alternative to tPA. This research is essential in determining the safest, most effective treatment for stroke patients on an individual level. It may also lead to expedited triage protocols in the emergency department and faster time to treatment.