Related Experiment Video
Updated: Dec 23, 2025
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
12.4K
Acute ischemic stroke: improving access to intravenous tissue plasminogen activator
Ashby C Turner1, Lee H Schwamm1, Mark R Etherton1
1Department of Neurology, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA.
Expert Review of Cardiovascular Therapy
|April 24, 2020
Summary
Improving access to alteplase (tissue plasminogen activator) for acute ischemic stroke involves optimizing stroke systems of care and utilizing advanced neuroimaging. These strategies aim to increase treatment rates for eligible patients.
Area of Science:
- Neurology
- Emergency Medicine
- Public Health
Background:
- Alteplase (tissue plasminogen activator) has been FDA-approved for acute ischemic stroke since 1996.
- Despite proven efficacy in improving stroke outcomes, its utilization remains suboptimal.
- Various strategies are being explored to enhance alteplase accessibility.
Purpose of the Study:
- To review recent approaches for improving alteplase access in acute ischemic stroke care.
- To discuss the role of stroke systems, quality initiatives, and telestroke networks.
- To highlight the potential of neuroimaging in expanding treatment eligibility.
Main Methods:
- Overview of stroke systems of care and quality improvement initiatives.
- Review of Telestroke network implementation for specialist access.
- Discussion of neuroimaging techniques for identifying extended treatment window candidates.
Main Results:
- Stroke systems, quality metrics, and Telestroke networks show promise in increasing alteplase utilization.
- Neuroimaging techniques offer new possibilities for treating patients with unknown symptom onset or beyond the standard window.
- Tailoring strategies to regional and population-specific needs is crucial for success.
Conclusions:
- Expanding alteplase access requires a multi-faceted approach considering local factors.
- Neuroimaging advancements are key to identifying more eligible patients, especially those outside the traditional 4.5-hour window.
- Continued innovation in stroke care delivery is essential to maximize the benefits of alteplase therapy.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
213
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
213
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
192
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
192
01:27Peripheral Artery Disease III: Interprofessional Care
178
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
178
01:16Clot Retraction and Fibrinolysis
8.1K
After a fibrin clot is formed, the next step is clot retraction, a vital process facilitated by platelet contractile proteins, such as actin and myosin. These proteins pull the fibrin strands closer together and condense the clot. This action reduces the size of the clot, creating a smaller, denser structure that effectively seals off the damaged vessel. Clot retraction consolidates the clot and helps with wound healing by bringing the edges of the damaged blood vessel closer together.
8.1K
01:28Acute Coronary Syndrome IV: Interprofessional Care
166
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
166
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
1.4K
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.4K