title: Four evolving strategies in the emergent treatment of acute ischemic stroke.
abstract: Stroke is the leading cause of long-term disability in the United States and is the fourth leading cause of death, affecting nearly 800,000 patients each year. The physical, emotional, and financial toll stroke inflicts on patients and their families cannot be overstated. At the forefront of acute stroke care, emergency clinicians are positioned to have a major impact on the quality of care that stroke patients receive. This issue outlines and reviews the literature on 4 evolving strategies reflecting developing advancements in the care of acute ischemic stroke and their potential to impact patients in the emergency department setting: (1) the expanding window for intravenous rt-PA, (2) the use of multimodal computed tomographic scanning in emergent diagnostic imaging, (3) endovascular therapies for stroke, and (4) stroke systems of care. Whether practicing in a tertiary care environment or in a remote emergency department, emergency clinicians will benefit from familiarizing themselves with these advancements and should consider how these new approaches might influence their management of patients with acute ischemic stroke.
authors.affiliation: Department of Emergency Medicine, VUMC Stroke Center, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: R Jason
authors.initials: RJ
authors.lastname: Thurman
authors.forename: Edward C
authors.initials: EC
authors.lastname: Jauch
authors.forename: Peter D
authors.initials: PD
authors.lastname: Panagos
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Reynolds
authors.forename: J
authors.initials: J
authors.lastname: Mocco
mesh_terms: D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D004632:Emergency Medical Services; D057510:Endovascular Procedures; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D012039:Regional Blood Flow; D012308:Risk Management; D020521:Stroke / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator