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  • Workshop Stroke Infarction1

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    Nugroho Sigit
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    The document discusses guidelines for the treatment of acute ischemic stroke. It recommends intravenous tissue plasminogen activator (IV rTPA) for strokes within 4.5 hours of onset when CT is negative for hemorrhage. For strokes between 3-4.5 hours, perfusion imaging can assess penumbra and identify patients likely to benefit from IV rTPA or mechanical clot retrieval. The guidelines also cover the use of additional imaging modalities like MRI and CTA/MRA to evaluate wake-up strokes and determine appropriate treatment.

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    Stroke infarct

    Original Title

    Workshop Stroke Infarction1.Pptx

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    The document discusses guidelines for the treatment of acute ischemic stroke. It recommends intravenous tissue plasminogen activator (IV rTPA) for strokes within 4.5 hours of onset when CT is negative for hemorrhage. For strokes between 3-4.5 hours, perfusion imaging can assess penumbra and identify patients likely to benefit from IV rTPA or mechanical clot retrieval. The guidelines also cover the use of additional imaging modalities like MRI and CTA/MRA to evaluate wake-up strokes and determine appropriate treatment.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    12 views57 pages

    Workshop Stroke Infarction1

    Uploaded by

    Nugroho Sigit
    The document discusses guidelines for the treatment of acute ischemic stroke. It recommends intravenous tissue plasminogen activator (IV rTPA) for strokes within 4.5 hours of onset when CT is negative for hemorrhage. For strokes between 3-4.5 hours, perfusion imaging can assess penumbra and identify patients likely to benefit from IV rTPA or mechanical clot retrieval. The guidelines also cover the use of additional imaging modalities like MRI and CTA/MRA to evaluate wake-up strokes and determine appropriate treatment.

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    © All Rights Reserved
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    of 57

    5/30/15

    Sri Andreani Utomo


    Department of Radiology, Dr. Soetomo Hospital,
    Faculty of Medicine, Airlangga University

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    A.  Iv rTPA
    B.  Ia rTPA
    C.  Mechanical clot retrieval
    D.  MRI to confirm acute infarction
    E.  Perfusion imaging to access
    penumbra

    }  2007: Guideline for adult ischemic stroke


    }  2009: Expansion of the time window for
    treatment of acute ischemic stroke with
    intravenous tissue plasminogen activator

    Iv rTPA indicated:
    }  When acute ischemic stroke onset within 4.5
    hours (2009 guidelines extending from 3
    hours recommended in 2007)
    }  Plain CT negative for hemorrhage

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    Follow up CT examination (24, 48 hours)


    - Hemorrhagic complications
    - Size of finally damaged area

    }  What is your opinion on wake up stroke?

    }  Problem: Long intervals between the time


    last seen well and time of symptom
    discovery

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    A.  Iv rTPA
    B.  Ia rTPA
    C.  Clot retrieval
    D.  Perfusion CT/MRI and CTA/MRA
    E.  Conservative treatment

    Infarction

    Penumbra

    Large Penumbra area

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    Small Penumbra

    DWI CBV

    MR more sensitive for posterior circulation

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    CBV CBF/MTT

    ra
    umb
    n
    n Pe
    CBV Inf
    ar ctio Infarc
    tion

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    Stroke Infarction Guidelines


    2009 ESO guidelines
    NECT
    PATIENT Emergency Department: physical, examination
    neurological examination, laboratory tests

    CTP, CTA/   no   CT positive


    over3  (4.5)   MRP,MRA   (hemorrhage,
    hours     tumour, stb.)
    within  3  (4.5)  
      yes  
    hours  

    MCA or MCA or Admission to


    T occlusion or T occlusion or neurology
    BA occlusion BA occlusion department or other
    department

    no   yes  
    yes   no  
    Admission to
    neurology
    department or IAT IVT-IAT IVT
    other department

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