RAIN 2018: Ischemic Stroke NIH U10 NS 086494 (PI) NorCal RCC - PowerPoint PPT Presentation

Disclosures RAIN 2018: Ischemic Stroke •NIH •U10 NS 086494 (PI) NorCal RCC •Consultant or stock ownership: • DSMB: Stryker Inc. Wade S. Smith, MD, PhD Wade S. Smith, MD, PhD Chief, UCSF Neurovascular Division Chief, UCSF Neurovascular Division Professor, UCSF Department of Neurology Professor, UCSF Department of Neurology Good Outcomes 50 45 40 19.1 35 30 Percent 25 20 13.6 16.9 MR CLEAN 15 REVASCAT 10 7.9 SWIFT-Prime N=1287 Randomized Patients 5 10 5 EXTEND IA 0 Control Intervention ESCAPE 0 1 2 1

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Nogueira et al, NEJM 378: 11-21,2018 Nogueira et al, NEJM 378: 11-21,2018 Nogueira et al, NEJM 378: 11-21,2018 3

Albers, et al, Epub NEJM January 24, 2018 Nogueira et al, NEJM 378: 11-21,2018 Albers, et al, Epub NEJM January 24, 2018 4

Outcomes by Time IV t-PA effect? 60 Ischemic Creep? 49 50 46 45 40 30 27 20 17 13 10 0 HERMES DAWN DEFUSE-3 Control Thrombectomy Albers, et al, Epub NEJM January 24, 2018 Late Window Paradox UCSF Acute Stroke Protocol Albers, Stroke: 2017 ePub 5

2018 UCSF Acute Stroke Protocol Major Conclusions • Embolectomy with stent retrievers improve clinical outcome if done with 24 hours of symptom onset for anterior circulation ischemia • Earlier treatment improves outcome if onset < 6 hours • Thrombectomy is safe and effective from 6-24 hours provided they have favorable perfusion • You should be performing CTA in all patients seen within 24 hours of ischemic stroke onset University of California, San Francisco 6