Physician Resources

How to Call

If you suspect your patient is having an acute stroke:
Internal staff call the operator at 8888, state “Brain Attack”, give the patient location, and give your name.
External staff, call the MD Network at 1-800-233-4082.

Remember:  Time Lost is Brain Lost

Acute Stroke Signs and Symptoms:

  • Sudden weakness or numbness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause
  • Initiate a Brain Attack if your patient has onset of these symptoms within six hours.


It is important to accurately determine time of symptom onset. If the exact time is unknown, the time of onset is considered the time the patient was last seen without symptoms. If a patient wakes with symptoms, the time of symptom onset is when they went to sleep.

Intravenous tPA Inclusion and Exclusion Criteria:

  • Inclusion Criteria: Diagnosis of ischemic stroke causing measurable, persistent neurological deficit. Onset of symptoms ≤ 3 hours to start of infusion.
     
  • Exclusion Criteria:
    • CT evidence of intracranial hemorrhage or multi-lobar infarction                 
    • HTN > 185 mmHg systolic and > 110 mmHg diastolic despite treatment
    • Prior intracranial hemorrhage
    • Head trauma, myocardial infarction, or stroke in previous three months
    • Rapidly improving deficits (suggestive of TIA)
    • Pregnant or lactating female
    • INR ≥ 1.7, PTT >34
    • Major surgery or trauma within fourteen days
    • Seizure associated with stroke onset
    • Platelet count < 100,000
    • Arterial puncture or LP within one week
    • GI or urinary bleeding within last three weeks


Assure inclusion and exclusion criteria met prior to infusing TPA.

Advanced Treatment Options for Ischemic Stroke

Time from Stroke Onset
IV tPA
IA tPA
Merci
Penumbra
Research Trials
0-3 hours
3-6 hours
√ (expanded window to 4.5 hours)
6-8 hours
 
 
8-24 hours
 
 
√ (posterior circulation and/or severe mismatch on perfusion imaging)
√ (posterior circulation and/or severe mismatch on perfusion imaging)

IA tPA

  • Moderate-severe stroke deficits
  • Used when IV tPA is contraindicated or no significant improvement after IV tPA therapy
  • Time to IA procedure start should be <5 hours (exception is acute basilar artery thrombosis/occlusions ***)

Merci Retrieval Device

  • Moderate-severe stroke deficits (NIHSS >8 and/or large vessel occlusion)
  • Used when IV tPA contraindicated or no significant improvement after IV tPA therapy
  • Time to procedure start should be <7 hours (exception is acute basilar artery thrombosis/occlusions ***)

Penumbra

  • Moderate-severe stroke deficits (NIHSS >8 and/or large vessel occlusion)
  • Used when IV tPA contraindicated or no significant improvement after IV tPA therapy
  • Time to procedure start should be <7 hours (exception is acute basilar artery thrombosis/occlusions ***)

*** Intervention for Basilar Artery Thrombosis/Occlusion may be attempted up to 24 hours from stroke onset

 

Acute Stroke Research Studies

  • Alias
  • Clear 3
  • IMS III
  • Stitch

 

MD Network: 800-233-4082

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