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Perspectives in Optimizing the Timely Delivery of Stroke Care

  1. According to published American Stroke Association (ASA)/American Heart Association (AHA) guidelines, which of the following patients with acute ischemic stroke (AIS) symptoms and without contraindications would be eligible for intravenous (IV) thrombolytics?
    55-year-old woman with last known well (LKW) 1.5 hours prior to presentation
    83-year-old man with diabetes and LKW 6 hours prior to presentation
    90-year-old woman with LKW 2 hours prior to presentation and a blood pressure (BP) of 195/118 mm Hg
    76-year-old man with LKW of 4 hours prior to presentation and initial blood glucose of 45 mg/dL
  2. In the NINDS trial, what was the percentage of patients receiving intravenous (IV) tissue plasminogen activator (tPA) compared to placebo who had a Modified Rankin Score (mrS) of ≤ 3 at 3 months?
  3. In the initial ASA/AHA guideline recommendation in 2015 for early management of AIS with endovascular treatment (EVT), which of the following represents mandatory criteria?
    Internal carotid artery (ICA) occlusion, National Institutes of Health Stroke Scale (NIHSS) ≥ 6, Alberta Stroke Program Early CT Score (ASPECTS) ≥ 6
    M2 middle cerebral artery (MCA) occlusion, pre-stroke mRS score of 0 to 1
    Treatment start (puncture time) within 8 hours after IV tissue plasminogen activator (tPA)
    ASPECT ≥ 2, pre-stroke mRS score of 0 to 3
  4. With the evolution of EVT for treatment of basilar artery occlusion in AIS, what is the ambulatory mRS at 3 months now compared to medical management when measured in absolute benefit?
  5. Based on pooled data for the EXTEND-ECASS4 and EPITHET trials looking at IV thrombolysis in AIS compared to placebo for an extended window of 4.5 to 9 hours, with use of perfusion imaging, the 90-day functional outcome based on mRS of 0 to 3 was: