Article Text
PDF
Statistics from Altmetric.com
In the modern era of stroke care, the clock is always ticking. We are all aware of the need to act ‘FAST’ to maximise the chance of a patient having a good outcome. ‘Time is brain’ is the mantra for delivery of thrombolysis and time to puncture is a nationally audited marker for thrombectomy care. However, for a variety of reasons, there can be delays in a patient reaching an interventional stroke centre. Some are outside of our control, for example, patients with an unknown onset time of their stroke. Others are within our control, such as basilar strokes that are demonstrably repeatedly missed clinically. Finally, unlike trauma we do not yet have the tight network infrastructure for rapid transfer of patients to an interventional stroke centre. What should we do for patients who fall outside clear trial-based National Institute for Health and Care Excellence (NICE) guidelines?
Thrombectomy within 12 hours for acute ischaemic stroke caused by anterior circulation large vessel occlusion dramatically changes functional outcomes for patients, with a number needed to treat to reduce disability by one point on the modified Rankin Scale score for one patient of 2.6.1 Such impressive outcomes make it tempting to …
Footnotes
Contributors I am the sole author of this editorial.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed by William Whiteley, Edinburgh, UK.
Linked Articles
- A difficult case
Read the full text or download the PDF:
Other content recommended for you
- Equivalent favorable outcomes possible after thrombectomy for posterior circulation large vessel occlusion compared with the anterior circulation: the MUSC experience
- Rationale and design of Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events III (TRACE III): a randomised, phase III, open-label, controlled trial
- Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial
- Outcomes after endovascular treatment for anterior circulation stroke presenting as wake-up strokes are not different than those with witnessed onset beyond 8 hours
- Visual assessment of diffusion weighted imaging infarct volume lacks accuracy and reliability
- Association between intraprocedural drops in blood pressure and infarct growth rate patterns after acute large-vessel occlusions
- Neuroimaging selection for thrombectomy in pediatric stroke: a single-center experience
- Thrombectomy 24 hours after stroke: beyond DAWN
- Indications for thrombectomy in acute ischemic stroke from emergent large vessel occlusion (ELVO): report of the SNIS Standards and Guidelines Committee
- Advances in mechanical thrombectomy for acute ischaemic stroke