Emergency Department Evaluation and Management of Patients with Acute Stroke and TIA
Acute Stroke Management, 6. Acute Antiplatelet therapy. Canadian Stroke best practices
Alteplase for Posterior Circulation Ischemic Stroke at 4.5 to 24 Hours. Yan S, Zhou Y, Lansberg MG, Liebeskind DS, Yuan C, Yu H, Chen F, Chen H, Zhang B, Mao L, Zhang X, Wang X, Zhang X, Chen Y, Zhou H, Zhong W, He Y, Chen K, Wang J, Chen H, Huang Y, Campbell BCV, Lou M; EXPECTS Group. N Engl J Med. 2025 Apr 3;392(13):1288-1296. doi: 10.1056/NEJMoa2413344. PMID: 40174223.
Tenecteplase versus alteplase for acute stroke within 4·5 h of onset (ATTEST-2): a randomised, parallel group, open-label trial. Muir KW, Ford GA, Ford I, Wardlaw JM, McConnachie A, Greenlaw N, Mair G, Sprigg N, Price CI, MacLeod MJ, Dima S, Venter M, Zhang L, O'Brien E, Sanyal R, Reid J, Sztriha LK, Haider S, Whiteley WN, Kennedy J, Perry R, Lakshmanan S, Chakrabarti A, Hassan A, Marigold R, Raghunathan S, Sims D, Bhandari M, Wiggam I, Rashed K, Douglass C; ATTEST-2 Investigators. Lancet Neurol. 2024 Nov;23(11):1087-1096. doi: 10.1016/S1474-4422(24)00377-6. PMID: 39424558.
Transient ischemic attack and minor stroke: diagnosis, risk stratification and management, Jeffrey J. Perry, Krishan Yadav, Shahbaz Syed and Michel Shamy, CMAJ October 11, 2022 194 (39) E1344-E1349; DOI: https://doi.org/10.1503/cmaj.220344
Trial of Endovascular Thrombectomy for Large Ischemic Strokes. Sarraj A, Hassan AE, Abraham MG, Ortega-Gutierrez S, Kasner SE, Hussain MS, Chen M, Blackburn S, Sitton CW, Churilov L, Sundararajan S, Hu YC, Herial NA, Jabbour P, Gibson D, Wallace AN, Arenillas JF, Tsai JP, Budzik RF, Hicks WJ, Kozak O, Yan B, Cordato DJ, Manning NW, Parsons MW, Hanel RA, Aghaebrahim AN, Wu TY, Cardona-Portela P, Pérez de la Ossa N, Schaafsma JD, Blasco J, Sangha N, Warach S, Gandhi CD, Kleinig TJ, Sahlein D, Elijovich L, Tekle W, Samaniego EA, Maali L, Abdulrazzak MA, Psychogios MN, Shuaib A, Pujara DK, Shaker F, Johns H, Sharma G, Yogendrakumar V, Ng FC, Rahbar MH, Cai C, Lavori P, Hamilton S, Nguyen T, Fifi JT, Davis S, Wechsler L, Pereira VM, Lansberg MG, Hill MD, Grotta JC, Ribo M, Campbell BC, Albers GW; SELECT2 Investigators. N Engl J Med. 2023 Feb 10. doi: 10.1056/NEJMoa2214403. Epub ahead of print. PMID: 36762865.
Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke: The DEVT Randomized Clinical Trial. Zi W, Qiu Z, Li F, et al. JAMA. 2021;325(3):234–243. doi:10.1001/jama.2020.23523
Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Fischer U, Kaesmacher J, Strbian D, Eker O, Cognard C, Plattner PS, Bütikofer L, Mordasini P, Deppeler S, Pereira VM, Albucher JF, Darcourt J, Bourcier R, Benoit G, Papagiannaki C, Ozkul-Wermester O, Sibolt G, Tiainen M, Gory B, Richard S, Liman J, Ernst MS, Boulanger M, Barbier C, Mechtouff L, Zhang L, Marnat G, Sibon I, Nikoubashman O, Reich A, Consoli A, Lapergue B, Ribo M, Tomasello A, Saleme S, Macian F, Moulin S, Pagano P, Saliou G, Carrera E, Janot K, Hernández-Pérez M, Pop R, Schiava LD, Luft AR, Piotin M, Gentric JC, Pikula A, Pfeilschifter W, Arnold M, Siddiqui AH, Froehler MT, Furlan AJ, Chapot R, Wiesmann M, Machi P, Diener HC, Kulcsar Z, Bonati LH, Bassetti CL, Mazighi M, Liebeskind DS, Saver JL, Gralla J; SWIFT DIRECT Collaborators. Lancet. 2022 Jul 9;400(10346):104-115. doi: 10.1016/S0140-6736(22)00537-2. PMID: 35810756.
A Randomized Trial of Intravenous Alteplase before Endovascular Treatment for Stroke. LeCouffe NE, Kappelhof M, Treurniet KM, Rinkel LA, Bruggeman AE, Berkhemer OA, Wolff L, van Voorst H, Tolhuisen ML, Dippel DWJ, van der Lugt A, van Es ACGM, Boiten J, Lycklama À Nijeholt GJ, Keizer K, Gons RAR, Yo LSF, van Oostenbrugge RJ, van Zwam WH, Roozenbeek B, van der Worp HB, Lo RTH, van den Wijngaard IR, de Ridder IR, Costalat V, Arquizan C, Lemmens R, Demeestere J, Hofmeijer J, Martens JM, Schonewille WJ, Vos JA, Uyttenboogaart M, Bokkers RPH, van Tuijl JH, Kortman H, Schreuder FHBM, Boogaarts HD, de Laat KF, van Dijk LC, den Hertog HM, van Hasselt BAAM, Brouwers PJAM, Bulut T, Remmers MJM, van Norden A, Imani F, Rozeman AD, Elgersma OEH, Desfontaines P, Brisbois D, Samson Y, Clarençon F, Krietemeijer GM, Postma AA, van Doormaal PJ, van den Berg R, van der Hoorn A, Beenen LFM, Nieboer D, Lingsma HF, Emmer BJ, Coutinho JM, Majoie CBLM, Roos YBWEM; MR CLEAN–NO IV Investigators. N Engl J Med. 2021 Nov 11;385(20):1833-1844. doi: 10.1056/NEJMoa2107727. PMID: 34758251.
Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association, Stroke; a Journal of Cerebral Circulation 2019 October 30, : STR0000000000000211
RECOMMANDATIONS CANADIENNES POUR LES PRATIQUES OPTIMALES DE SOINS DE L’AVC: PRISE EN CHARGE DE L’AVC EN PHASE AIGUË : PRISE EN CHARGE DE L’AVC EN PHASE AIGUË EN MILIEU PREHOSPITALIER, AU SERVICE DES URGENCES ET CHEZ LE PATIENT HOSPITALISE, Mise à jour 2018
TABLEAU 2A : Résumé des niveaux de risque d’AVC récidivant et prise en charge initiale selon les Recommandations canadiennes pour les pratiques optimales de l’AVC
RECOMMANDATIONS CANADIENNES POUR LES PRATIQUES OPTIMALES DE SOINS DE L’AVC PRISE EN CHARGE DE L’HÉMORRAGIE INTRACÉRÉBRALE SPONTANÉE, Septième édition, Fondation des maladies du cœur et de l’AVC du Canada, Octobre 2020
RECOMMANDATIONS CANADIENNES POUR LES PRATIQUES OPTIMALES DE SOINS DE L’AVC: Accident vasculaire cérébral pendant la grossesse, Juillet 2018
Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; American Heart Association Stroke Council and Council on Epidemiology and Prevention. Stroke. 2016 Feb;47(2):581-641. doi: 10.1161/STR.0000000000000086. Epub 2015 Dec 22. Erratum in: Stroke. 2016 Nov;47(11):e262. PMID: 26696642.
EXTEND-IA TNK Investigators. Safety and Efficacy of Tenecteplase in Older Patients With Large Vessel Occlusion: A Pooled Analysis of the EXTEND-IA TNK Trials. Yogendrakumar V, Churilov L, Mitchell PJ, Kleinig TJ, Yassi N, Thijs V, Wu TY, Shah DG, Ng FC, Dewey HM, Wijeratne T, Yan B, Desmond PM, Parsons MW, Donnan GA, Davis SM, Campbell BCV; Neurology. 2022 Mar 22;98(12):e1292-e1301. doi: 10.1212/WNL.0000000000013302. Epub 2022 Jan 11. PMID: 35017305.
Endovascular Therapy for Stroke Due to Basilar-Artery Occlusion. Langezaal LCM, van der Hoeven EJRJ, Mont'Alverne FJA, de Carvalho JJF, Lima FO, Dippel DWJ, van der Lugt A, Lo RTH, Boiten J, Lycklama À Nijeholt GJ, Staals J, van Zwam WH, Nederkoorn PJ, Majoie CBLM, Gerber JC, Mazighi M, Piotin M, Zini A, Vallone S, Hofmeijer J, Martins SO, Nolte CH, Szabo K, Dias FA, Abud DG, Wermer MJH, Remmers MJM, Schneider H, Rueckert CM, de Laat KF, Yoo AJ, van Doormaal PJ, van Es ACGM, Emmer BJ, Michel P, Puetz V, Audebert HJ, Pontes-Neto OM, Vos JA, Kappelle LJ, Algra A, Schonewille WJ; BASICS Study Group. N Engl J Med. 2021 May 20;384(20):1910-1920. doi: 10.1056/NEJMoa2030297. PMID: 34010530.
Prospective validation of Canadian TIA Score and comparison with ABCD2 and ABCD2i for subsequent stroke risk after transient ischaemic attack: multicentre prospective cohort study, Perry Jeffrey J, Sivilotti Marco L A, Émond Marcel, Stiell Ian G, Stotts Grant, Lee Jacques et al. BMJ 2021; 372 :n49
Evaluation of unknown Onset Stroke thrombolysis trials (EOS) investigators. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data. Thomalla G, Boutitie F, Ma H, Koga M, Ringleb P, Schwamm LH, Wu O, Bendszus M, Bladin CF, Campbell BCV, Cheng B, Churilov L, Ebinger M, Endres M, Fiebach JB, Fukuda-Doi M, Inoue M, Kleinig TJ, Latour LL, Lemmens R, Levi CR, Leys D, Miwa K, Molina CA, Muir KW, Nighoghossian N, Parsons MW, Pedraza S, Schellinger PD, Schwab S, Simonsen CZ, Song SS, Thijs V, Toni D, Hsu CY, Wahlgren N, Yamamoto H, Yassi N, Yoshimura S, Warach S, Hacke W, Toyoda K, Donnan GA, Davis SM, Gerloff C; Lancet. 2020 Nov 14;396(10262):1574-1584. doi: 10.1016/S0140-6736(20)32163-2. Epub 2020 Nov 8. PMID: 33176180; PMCID: PMC7734592.
How should we treat patients who wake up with a stroke? A review of recent advances in management of acute ischemic stroke, D Biggs, M E Silverman, F Chen, B Walsh, P Wynne, American Journal of Emergency Medicine 2019 February 21
Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack, A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association, Stroke July 2014
Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging, N Engl J Med. 2018 Feb 22;378(8):708-718. doi: 10.1056/NEJMoa1713973. Epub 2018 Jan 24.
CONCLUSIONS: Endovascular thrombectomy for ischemic stroke 6 to 16 hours after a patient was last known to be well plus standard medical therapy resulted in better functional outcomes than standard medical therapy alone among patients with proximal middle-cerebral-artery or internal-carotid-artery occlusion and a region of tissue that was ischemic but not yet infarcted. (Funded by the National Institute of Neurological Disorders and Stroke; DEFUSE 3 ClinicalTrials.gov number, NCT02586415 .).
DIRECT-MT Investigators. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. Yang P, Zhang Y, Zhang L, Zhang Y, Treurniet KM, Chen W, Peng Y, Han H, Wang J, Wang S, Yin C, Liu S, Wang P, Fang Q, Shi H, Yang J, Wen C, Li C, Jiang C, Sun J, Yue X, Lou M, Zhang M, Shu H, Sun D, Liang H, Li T, Guo F, Ke K, Yuan H, Wang G, Yang W, Shi H, Li T, Li Z, Xing P, Zhang P, Zhou Y, Wang H, Xu Y, Huang Q, Wu T, Zhao R, Li Q, Fang Y, Wang L, Lu J, Li Y, Fu J, Zhong X, Wang Y, Wang L, Goyal M, Dippel DWJ, Hong B, Deng B, Roos YBWEM, Majoie CBLM, Liu J; N Engl J Med. 2020 May 21;382(21):1981-1993. doi: 10.1056/NEJMoa2001123. Epub 2020 May 6. PMID: 32374959.
The VITAL study and overall pooled analysis with the VIPS non-invasive stroke detection device, Kellner CP, Sauvageau E, Snyder KV, et al, Journal of NeuroInterventional Surgery Published Online First: 06 March 2018. doi: 10.1136/neurintsurg-2017-013690
HSF - Stroke Assessment Pocket Guide
Calculateur NIH Stroke Scale en Français (NIHSS)
M2 segment of the middle cerebral artery
Comment évaluer la force musculaire, Merck Manual : échelle 0 à 5
Hypertension AVC
Early versus delayed antihypertensive treatment in patients with acute ischaemic stroke: multicentre, open label, randomised, controlled trial Liu L, Xie X, Pan Y, Wang A, Wei Y, Liu J et al. BMJ 2023; 383 :e076448 doi:10.1136/bmj-2023-076448
Outcomes of Intensive Systolic Blood Pressure Reduction in Patients With Intracerebral Hemorrhage and Excessively High Initial Systolic Blood Pressure: Post Hoc Analysis of a Randomized Clinical Trial. Qureshi AI, Huang W, Lobanova I, Barsan WG, Hanley DF, Hsu CY, Lin CL, Silbergleit R, Steiner T, Suarez JI, Toyoda K, Yamamoto H; for ATACH-II trial investigators. JAMA Neurol. 2020 Sep 8;77(11):1–11. doi: 10.1001/jamaneurol.2020.3075. Epub ahead of print. PMID: 32897310; PMCID: PMC7489424.
Plavix
Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis. Hao Q, Tampi M, O'Donnell M, Foroutan F, Siemieniuk RA, Guyatt G. BMJ. 2018 Dec 18;363:k5108. doi: 10.1136/bmj.k5108.
CONCLUSIONS: Dual antiplatelet therapy with clopidogrel and aspirin given within 24 hours after high risk TIA or minor ischaemic stroke reduces subsequent stroke by about 20 in 1000 population, with a possible increase in moderate to severe bleeding of 2 per 1000 population. Discontinuation of dual antiplatelet therapy within 21 days, and possibly as early as 10 days, of initiation is likely to maximise benefit and minimise harms.