International Stroke Conference
January 24–26

Alexis N. Simpkins, MD, PhD

Session: Acute Ischemic Stroke Guidelines
Date: Wednesday, January 24, 2018

Speakers: William Powers, MD, FAHA, University of North Carolina; Opeolu Adeoya, MD, University of Cincinnati; Alejandro Rabinstein, MD, Mayo Clinic; Thabele Leslie-Mazwi, MD, Massachusetts General Hospital

Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018

The new American Heart Association acute ischemic stroke guidelines were presented at the 2018 International Stroke Conference in Los Angeles. There were several new notable recommendations and updates, which are now published. Some of the updates emphasized during the presentation addressed mild stroke symptoms in the 3-4.5 hour time window for intravenous alteplase, indications for tenecteplase, risk of intracerebral hemorrhage with intravenous thrombolysis in patients with cerebral microbleeds, anti-thrombotic use within 24 hours of intravenous thrombolysis, triage of patients in the field by EMS to tPA capable versus tPA/mechanical thrombectomy capable hospitals, and tPA eligibility in adult patients with sickle cell disease.

In addition to incorporation of the recent clinical trials DAWN and DEFUSE 3, the revised mechanical thrombectomy recommendations also addressed whether testing renal function should be required prior to CT contrast administration, differentiating when perfusion imaging should be considered for patient selection for mechanical thrombectomy, and the use of general anesthesia during mechanical thrombectomy. Of note, specific recommendations for the type of methodology that should be used for volumetric measurements when selecting patients by DEFUSE 3 or DAWN criteria was not included in the guidelines.

There were also updates on management of stroke patients regarding evidence for diagnostic testing, the prevention of venous thromboembolism, dysphagia screening, and timing of interventions needed to address carotid artery stenosis for secondary stroke prevention.

After the presentation, I was able to briefly talk to the chair of the committee, William Powers, MD, FAHA, University of North Carolina, who emphasized that the goal of the guidelines was to provide recommendations backed by evidence proven to improve clinical outcome in patients.