Expanded Window for Acute Stroke Intervention

A timely response really works when it comes to stroke intervention. Lengthened lack of blood flow following a stroke can cause irreversible damage, often resulting in disability. In many cases of stroke, intervention methods are used to save tissue. 

Until now, a limited window of time was recommended for intervention of stroke. But as per new precepts given by The American Heart Association and American Stroke Association in January 2019, an extended window for surgery is suitable for the patients with acute ischemic stroke. 

The studies were examined by a group of highly qualified experts in stroke care and are the wide-ranging recommendations for treating ischemic stroke issued since 2013. 

About 20% of acute ischemic stroke are categorized as wake-up strokes, which falls out of the conventional treatment time window so this lengthened timeframe is expected to reduce the risk of disability and provide opportunity for recovery to an increased number of future stroke patients. 

A surgical procedure called mechanical thrombectomy lengthens the time window to 24 hours for selected acute ischemic stroke patients. This recommendation is only advisable in clots that block large vessels. It is likely to result in more patients becoming eligible for thrombectomy since more patients will be treated based on clinical presentation rather than a time cut-off alone. Thus, it has the potential to benefit more people and it has completely changed the background of acute stroke treatment. 

This new guideline states that large vessel strokes can safely be treated with mechanical thrombectomy up to 16 hours after a stroke in selected patients. The expanded treatment window from six to 16 hours is based on clinical evidence from the DAWN and DEFUSE 3 trials. In certain situations, advanced brain imaging plays a crucial role in identifying patients who could benefit from 24 hours of treatment with mechanical thrombectomy, based on the DAWN Trial criteria. 

These guidelines are adopted with a purpose of providing advanced comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. They address:- 

• prehospital care; 
• urgent and emergency evaluation; 
• treatment with intravenous and intra-arterial therapies; 
• In-hospital management including secondary prevention measures that are appropriately instituted within the first two weeks.

Another new theory widens the eligibility for administering intravenous alteplase, the only US FDA-approved clot-dissolving treatment for ischemic stroke. The new research helps some of these patients with mild strokes that were previously not eligible for clot-busting treatment. The new guideline says that the drug can decrease disability, provided it is given promptly and appropriately to the patients after weighing the risks and benefits in individual patients.