Canadian Stroke Best Practice Recommendations: Hyperacute Stroke Care Guidelines, Update 2015

Area of Science:

• Neurology
• Cardiovascular Medicine
• Emergency Medicine

Background:

• The 2015 update addresses hyperacute care for various stroke types, including transient ischemic attack (TIA), ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and acute venous sinus thrombosis.
• A significant revision includes new recommendations for endovascular therapy in acute ischemic stroke with proximal intracranial arterial occlusion.

Purpose of the Study:

• To outline essential components for the initial assessment, stabilization, and treatment of acute stroke patients.
• To detail the infrastructure, resources, and regional structures necessary for stroke centers offering endovascular therapy.
• To establish patient selection criteria and performance metrics for endovascular therapy, focusing on minimizing time to reperfusion.

Main Methods:

• Incorporation of recommendations for advanced neuroimaging, including computed tomography angiography and perfusion.
• Integration of patient selection criteria derived from five major endovascular therapy trials published in 2015.
• Emphasis on improving time efficiencies across all hyperacute stroke care aspects, targeting a median door-to-needle time of 30 minutes.

Main Results:

• Introduction of new guidelines for endovascular therapy, expanding treatment options for eligible acute ischemic stroke patients.
• Implementation of strategies to enhance public awareness and prehospital care, including paramedic notification and public campaigns like FAST.
• Updated recommendations for blood pressure management in the hyperacute phase for different stroke types.

Conclusions:

• The updated recommendations aim to improve the efficiency of hyperacute stroke care, reducing the time from symptom onset to reperfusion.
• Enhanced access to endovascular therapy and optimized prehospital and in-hospital care are expected to lead to better patient outcomes and potentially faster recovery.
• The guideline emphasizes a coordinated approach involving the public, paramedics, emergency departments, and stroke teams to ensure timely and effective stroke management.