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Update in Ischemic Stroke 2004

Update in Ischemic Stroke 2004. Timothy Lukovits, M.D. Co-Director, Dartmouth Stroke Program. “Stroke Unit” 1960 and 2004. Stroke Care 1960. Stroke Care 2004. ACGME-approved stroke fellowships ABPN subspecialty certification in stroke neurology. Expected benefits of primary stroke centers.

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Update in Ischemic Stroke 2004

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  1. Update in Ischemic Stroke 2004 Timothy Lukovits, M.D. Co-Director, Dartmouth Stroke Program

  2. “Stroke Unit” 1960 and 2004

  3. Stroke Care 1960 Stroke Care 2004

  4. ACGME-approved stroke fellowships • ABPN subspecialty certification in stroke neurology

  5. Expected benefits of primary stroke centers • Improved efficiency of patient care • Fewer peri-stroke complications • Increased use of acute stroke therapies • Reduced morbidity and mortality • Improved long-term outcomes • Reduced costs • Increased patient satisfaction

  6. Checks patient information against applicable AHA/ASA Guidelines (Stroke and CAD)

  7. Pilot data from the New England Get With the Guidelines program (12-month results) LaBresh, K. A. et al. Arch Intern Med 2004;164:203-209. Copyright restrictions may apply.

  8. Also, health departments in Mass. and NY beginning certification of stroke centers

  9. Question 1 for the audience • Is there a need for stroke centers? • Yes • No

  10. Question 2 for the audience • Does the benefit of t-PA outweigh the risk? • Yes • No

  11. 8 years after FDA approval and even more controversial !

  12. DWI (Diffusion Weighted Imaging)PWI(Perfusion Weighted Imaging)

  13. Diffusion weighted imaging Isolated weakness right index finger JS Kim, Neurology, 2002

  14. “Mismatch” = PWI volume 20% >DWIvolume Good tPA candidate Possible tPA candidate Questionable tPA candidate

  15. Amyloid angiopathy: a risk factor for warfarin and thrombolytic related ICH:

  16. CT/CTA CTPerfusion PWI/DWI/MRA

  17. Mechanical thrombolysis

  18. Advantages of mechanical thrombolysis • Decreased or no need for lytic agent • More rapid and effective clot disruption

  19. Concentric Retriever device

  20. FDA approval August 2004

  21. Ultrasound-enhanced lysis

  22. Carotid stenting

  23. Carotid angioplasty and stenting: an evolving technology

  24. FDA HDE for PFO closure devices

  25. How do we apply these advances in New Hampshire? • We have many small hospitals separated by miles, mountains and misgivings? • Limited interest or resources in stroke

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