Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion
Abstract Background Groundbreaking study results since 2014 have dramatically changed the therapeutic options in acute therapy for severe ischemic stroke caused by large vessel occlusion (LVO). The scientifically proven advances in stroke imaging and thrombectomy techniques have allowed to offer the...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-05-01
|
| Series: | Neurological Research and Practice |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s42466-023-00245-9 |
| _version_ | 1797822614463315968 |
|---|---|
| author | Julian Bösel Gordian J. Hubert Jessica Jesser Markus A. Möhlenbruch Peter A. Ringleb |
| author_facet | Julian Bösel Gordian J. Hubert Jessica Jesser Markus A. Möhlenbruch Peter A. Ringleb |
| author_sort | Julian Bösel |
| collection | DOAJ |
| description | Abstract Background Groundbreaking study results since 2014 have dramatically changed the therapeutic options in acute therapy for severe ischemic stroke caused by large vessel occlusion (LVO). The scientifically proven advances in stroke imaging and thrombectomy techniques have allowed to offer the optimal version or combination of best medical and interventional therapy to the selected patient, yielding favorable or even excellent clinical outcomes within time windows unheard of before. The provision of the best possible individual therapy has become a guideline-based gold standard, but remains a great challenge. With geographic, regional, cultural, economic and resource differences worldwide, optimal local solutions have to be strived for. Aim This standard operation procedure (SOP) is aimed to give a suggestion of how to give patients access to and apply modern recanalizing therapy for acute ischemic stroke caused by LVO. Method The SOP was developed based on current guidelines, the evidence from the most recent trials and the experience of authors who have been involved in the above-named development at different levels. Results This SOP is meant to be a comprehensive, yet not too detailed template to allow for freedom in local adaption. It comprises all relevant stages in providing care to the patient with severe ischemic stroke such as suspicion and alarm, prehospital acute measures, recognition and grading, transport, emergency room workup, selective cerebral imaging, differential treatment by recanalizing therapies (intravenous thrombolysis, endovascular stroke treatmet, or combined), complications, stroke unit and neurocritical care. Conclusions The challenge of giving patients access to and applying recanalizing therapies in severe ischemic stroke may be facilitated by a systematic, SOP-based approach adapted to local settings. |
| first_indexed | 2024-03-13T10:11:43Z |
| format | Article |
| id | doaj.art-9bc80cf36e9b4d02afb8c2c647df54f7 |
| institution | Directory Open Access Journal |
| issn | 2524-3489 |
| language | English |
| last_indexed | 2024-03-13T10:11:43Z |
| publishDate | 2023-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Neurological Research and Practice |
| spelling | doaj.art-9bc80cf36e9b4d02afb8c2c647df54f72023-05-21T11:30:52ZengBMCNeurological Research and Practice2524-34892023-05-015111110.1186/s42466-023-00245-9Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusionJulian Bösel0Gordian J. Hubert1Jessica Jesser2Markus A. Möhlenbruch3Peter A. Ringleb4Department of Neurology, University Hospital HeidelbergTEMPiS Telestroke Center, Department of Neurology, München Klinik, Academic Teaching Hospital of the Ludwig-Maximilians-University, MunichDepartment of Neuroradiology, University Hospital HeidelbergDepartment of Neuroradiology, University Hospital HeidelbergDepartment of Neurology, University Hospital HeidelbergAbstract Background Groundbreaking study results since 2014 have dramatically changed the therapeutic options in acute therapy for severe ischemic stroke caused by large vessel occlusion (LVO). The scientifically proven advances in stroke imaging and thrombectomy techniques have allowed to offer the optimal version or combination of best medical and interventional therapy to the selected patient, yielding favorable or even excellent clinical outcomes within time windows unheard of before. The provision of the best possible individual therapy has become a guideline-based gold standard, but remains a great challenge. With geographic, regional, cultural, economic and resource differences worldwide, optimal local solutions have to be strived for. Aim This standard operation procedure (SOP) is aimed to give a suggestion of how to give patients access to and apply modern recanalizing therapy for acute ischemic stroke caused by LVO. Method The SOP was developed based on current guidelines, the evidence from the most recent trials and the experience of authors who have been involved in the above-named development at different levels. Results This SOP is meant to be a comprehensive, yet not too detailed template to allow for freedom in local adaption. It comprises all relevant stages in providing care to the patient with severe ischemic stroke such as suspicion and alarm, prehospital acute measures, recognition and grading, transport, emergency room workup, selective cerebral imaging, differential treatment by recanalizing therapies (intravenous thrombolysis, endovascular stroke treatmet, or combined), complications, stroke unit and neurocritical care. Conclusions The challenge of giving patients access to and applying recanalizing therapies in severe ischemic stroke may be facilitated by a systematic, SOP-based approach adapted to local settings.https://doi.org/10.1186/s42466-023-00245-9Large vessel occlusionSevere strokeAcute ischemic strokeIntravenous thrombolysisEndovascular stroke treatmentStroke thrombectomy |
| spellingShingle | Julian Bösel Gordian J. Hubert Jessica Jesser Markus A. Möhlenbruch Peter A. Ringleb Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion Neurological Research and Practice Large vessel occlusion Severe stroke Acute ischemic stroke Intravenous thrombolysis Endovascular stroke treatment Stroke thrombectomy |
| title | Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion |
| title_full | Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion |
| title_fullStr | Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion |
| title_full_unstemmed | Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion |
| title_short | Access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion |
| title_sort | access to and application of recanalizing therapies for severe acute ischemic stroke caused by large vessel occlusion |
| topic | Large vessel occlusion Severe stroke Acute ischemic stroke Intravenous thrombolysis Endovascular stroke treatment Stroke thrombectomy |
| url | https://doi.org/10.1186/s42466-023-00245-9 |
| work_keys_str_mv | AT julianbosel accesstoandapplicationofrecanalizingtherapiesforsevereacuteischemicstrokecausedbylargevesselocclusion AT gordianjhubert accesstoandapplicationofrecanalizingtherapiesforsevereacuteischemicstrokecausedbylargevesselocclusion AT jessicajesser accesstoandapplicationofrecanalizingtherapiesforsevereacuteischemicstrokecausedbylargevesselocclusion AT markusamohlenbruch accesstoandapplicationofrecanalizingtherapiesforsevereacuteischemicstrokecausedbylargevesselocclusion AT peteraringleb accesstoandapplicationofrecanalizingtherapiesforsevereacuteischemicstrokecausedbylargevesselocclusion |