Topic: "How do you manage acute ischemic stroke?"

 

Practice Buzz: Giving voice to neurology professionals worldwide

Practice Buzz is a new, innovative, spin-off project of Practice Current. Our worldwide surveys will focus on targeted questions for healthcare providers in neurology ranging from hot topics in clinical practice to contemporary issues in work/life balance and blind spots in topics of inclusion, equity, and diversity.

Survey results will be available on an interactive world map along with several comments from international panelists, with emphasis on inclusion and diversity of backgrounds and opinions

Our goal is to give all neurology professionals worldwide a voice.

 

Survey Questions (mobile view)

 

View Results on Interactive Map (Open in new window)

 

Research Team

Nishita Singh, MD and Aravind Ganesh, MD, DPhil 

“Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are both approved and widely used therapies in acute ischemic stroke with large vessel occlusion.1 Although EVT became a standard of care since 2015, recent trials like DIRECT-MT, MR CLEAN NO-IV and others2 have questioned whether this new treatment should replace or complement IVT. In addition, alteplase has been the traditional approved thrombolytic of choice for use in ischemic stroke. However, some parts of the world have shifted to use tenecteplase for a variety of pharmacologic and economic reasons.3, 4 The AcT trial which was recently presented at an international stroke conference showed that tenecteplase (0.25mg/kg) is non-inferior to alteplase in patients with acute ischemic stroke presenting within 4.5h of symptom onset and the effect size was larger in patients who presented with large vessel occlusion in favor of tenecteplase. NORTEST 2 (part A) was yet another trial presented but the study used a higher dose of tenecteplase (0.4mg/kg) and was terminated early due to safety concerns.5 We seek to understand current practices around the world for treating acute ischemic stroke with large vessel occlusion.

References:

  1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418.
  2. Burgos AM, Saver JL. Evidence that Tenecteplase Is Noninferior to Alteplase for Acute Ischemic Stroke: Meta-Analysis of 5 Randomized Trials. Stroke. 2019;50(8):2156-62.
  3. Putaala J, Saver JL, Nour M, Kleindorfer D, McDermott M, Kaste M. Should Tenecteplase be Given in Clinical Practice for Acute Ischemic Stroke Thrombolysis? Stroke. 2021;52(9):3075-80.
  4. Warach SJ, Saver JL. Stroke Thrombolysis With Tenecteplase to Reduce Emergency Department Spread of Coronavirus Disease 2019 and Shortages of Alteplase. JAMA Neurol. 2020;77(10):1203-4.
  5. https://2022.eso-conference.org/wp-content/uploads/2022/05/ESOC-22-Daily-Press-Release-1-Wed-4-May-FINAL-2.0.pdf [press release]. 2022.

 

 

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