“Sutor, ne ultra crepidam” a Latin expression for shoemakers not beyond the shoe, a common saying to warn people to avoid passing a judgment beyond their expertise. With mechanical thrombectomy changing the management of stroke and becoming the standard of care for patients with large vessel occlusion (LVO), a new challenge has emerged, adequate access … Read more
I’m spending the last month of internal medicine residency on a neurology rotation. I suppose that’s fair; my wife, a neurology resident, had to do a whole year of medicine. To me, the most interesting part of neurology is the parallel between stroke and acute myocardial infarction (AMI). Conceptually these are two manifestations of a … Read more
A typical referral letter arrives in my tray: A 55-year-old diabetic female noticed pain and discoloration of the right foot for several days. Immediate admission was arranged for this patient: A junior resident presents the case. She has clerked the patient and filled all the necessary forms and ticked all the necessary boxes. Everything … Read more
In 1996, intravenous alteplase was approved by the FDA for treatment of acute ischemic stroke within 3 hours of time of onset of symptoms. Since then it remains the only drug approved for treatment of acute ischemic stroke. Subsequent clinical trial showed benefit of alteplase unto 4.5 hours from onset of symptoms. Over the past … Read more
(In anticipation of the International Stroke Conference 2019 – ISC19) Not so long ago, the benefit of endovascular thrombectomy beyond six hours of ischemic stroke onset was uncertain, particularly among patients with ischemic brain tissue that has not yet undergone infarction. The volume of irreversibly injured ischemic tissue and the volume of brain tissue that … Read more
Advances in science cannot overcome traffic. Patients with strokes due to large vessel occlusions must be taken to hospitals that perform endovascular thrombectomy. Otherwise, these patients do not benefit from the latest and greatest in stroke neurology. Investigators, including me, have taken interest in measuring the impact of travel delays on stroke care. With my … Read more
To fanfare at International Stroke Conference 2018, the results of the DEFUSE 31 extended window thrombectomy study were announced. The American Heart Association/American Stroke Association acute ischemic stroke guidelines were immediately updated to reflect the practice-changing findings. A few months later, Lee Schwamm and colleagues published their findings from MR WITNESS.2 In this study, patients … Read more
A recent New York Times article re-surfaced the ‘debate’ regarding alteplase (IV-tPA) for ischemic stroke.1 There are some who continue to argue that the data for IV-tPA are not convincing. In this context, and otherwise, it is worthwhile to discuss a recent study comparing tenecteplase versus alteplase among patients with large vessel occlusion.2 In this … Read more