Acute Stroke Management
As per the Canadian Stroke Best Practice Recommendations – acute stroke management encompasses pre-hospital, emergency department and acute inpatient stroke care. Please refer to the Acute Stroke Management Update 2018 for further details.
The period of time from when a person calls 911 to arrival to the Stroke Centre Emergency department is often referred to as the Hyperacute period. All patients with suspected acute stroke would receive rapid assessment and undergo brain imaging on arrival to determine eligibility for the intravenous drug tPA (tissue-plasminogen activator) also known as the “clot buster”. Administration of tPA soon after onset of symptoms can limit irreversible ischemic damage.
“All patients with suspected ischemic stroke who arrive at 6-24 hours after stroke onset (late presentation and stroke on awakening with unknown onset time) and are potentially eligible for late window endovascular thrombectomy treatment should undergo immediate brain imaging with non-contrast CT with CTA and CT perfusion, or MRI with MRA and MRP [Evidence Level B].” Acute Stroke Management Update 2018
On March 5th, 2020 CESN held a webinar for regional consultation regarding the “Process for Non-tPA Hospitals to Access Stroke Consultation and/or EVT Services for Patients Presenting within 6-24 Hours of Stroke Symptom Onset”
To view webinar CLICK HERE
Webinar slides are available in handout format – CLICK HERE
Patients with an acute stroke or transient ischemic attack would be admitted to a stroke centre and receive care on an inpatient stroke unit. A Stroke Unit is a geographically defined hospital unit dedicated to the management of stroke patients [Evidence Level A]. This unit is staffed by an interdisciplinary health care team who provide coordinated, best practice stroke care. Stroke patients who receive stroke unit care are more likely to survive, return home, and be independent than stroke patients who receive less organized, general ward care (Stroke Unit Trialists’ Collaboration 2009).
Telestroke is an emergency telemedicine application using videoconferencing technology. Telestroke sites can provide assessment and treatment of patients experiencing acute stroke via consultation with a provincial Telestroke neurologist. The neurologist can view the patient’s CT scan electronically, “see” the patient using live video and discuss results with the patient’s physician. In CESN currently 4 sites have access to Telestroke: Royal Victoria Regional Health Centre, Barrie; Muskoka Algonquin Health Centre, Huntsville; Peterborough Regional Health Centre; Peterborough; and Lakeridge Health, Oshawa.