2 october 2017 – 8:40
Department of Interventional Neuroradiology, A. de Rothschild Foundation, Paris, France
In 2017, deciding whether a suspected stroke patient receives thrombolysis as fast as possible or be sent to the nearest endovascular-capable stroke center remains undecided. Join M. Piotin as he reviews what we know today about the relative benefits of each protocol: thrombolysis at a primary stroke center (PSC) – the “Drip & Ship” method – or immediate transportation to a primary endovascular-capable stroke center, a Comprehensive Stroke Center (CSC) or “Mothership”.
Each solution brings with it a large series of questions and M. Piotin dissects the available data and trials, such as MR CLEAN and RACECAT, to see how each protocol ultimately performs. Can the CSC respond to the large influx of patient population if there is no LVO, non-LVO triage? Or what about the percentage of patients with stroke “mimics”? While imaging procedures at a PSC could determine whether a patient has a large vessel occlusion (LVO) and iv TPA begun before transport to the CSC, is “quicker is better” in the case TPA the whole story?
What does the future hold? Good cooperation between the PSC and CSC? New forms of organization may such as mobile stroke units? Will the method for LVO analysis evolve? Will bridging therapy still be required, or will MT alone be shown to be non-inferior to MT+iVT? How will our methodology change? What randomized clinical trials are still necessary? The questions remain abundant and challenging, the audience discussion led by W.H. Van Zwam, passionate…and you can learn more by watching here. Where do you stand?