2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke
2018; Lippincott Williams & Wilkins; Volume: 49; Issue: 3 Linguagem: Inglês
10.1161/strokeaha.118.020176
ISSN1524-4628
AutoresKaren L. Furie, Mahesh Jayaraman,
Tópico(s)Neurological Disorders and Treatments
ResumoHomeStrokeVol. 49, No. 32018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUB2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Karen L. Furie, MD, MPH and Mahesh V. Jayaraman, MD Karen L. FurieKaren L. Furie From the Rhode Island Hospital (K.L.F., M.V.J.), Miriam Hospital (K.L.F.), and Bradley Hospital (K.L.F.), Warren Alpert Medical School, Brown University, Providence, RI. and Mahesh V. JayaramanMahesh V. Jayaraman From the Rhode Island Hospital (K.L.F., M.V.J.), Miriam Hospital (K.L.F.), and Bradley Hospital (K.L.F.), Warren Alpert Medical School, Brown University, Providence, RI. Originally published24 Jan 2018https://doi.org/10.1161/STROKEAHA.118.020176Stroke. 2018;49:509–510Given the seismic changes we have seen in stroke care over the past 5 years, the stroke community has been eagerly anticipating the 2018 updated Acute Ischemic Stroke Guideline.1 This comprehensive document defines state-of-the-art acute stroke management. We highlight a few selected areas of change relevant to stroke systems of care, imaging, thrombectomy eligibility, postprocedure management, and secondary prevention.Most current stroke systems of care are designed to have Emergency Medical Services transport suspected stroke patients to the closest stroke center, regardless of its infrastructure and subspecialty expertise. Unlike intravenous alteplase, the successful delivery of mechanical thrombectomy requires specialized services unavailable at most hospitals. An important area of future study will be if there is a benefit to bypassing a closer hospital without thrombectomy capabilities to transport patients directly in the field to a Comprehensive Stroke Center, where thrombectomy can be performed more expeditiously. As the authors summarize, there is insufficient evidence to recommend one field severity scale over another, but the implementation of a severity-based algorithm such as the Mission: Lifeline Severity-Based Stroke Triage Algorithm for Emergency Medical Services (http://www.heart.org/missionlifelinestroke) has the potential to increase access to thrombectomy. Hopefully, future research can determine the optimal methods for triaging patients appropriately from the field.Imaging is central to the management of the acute stroke patient. Historically, parenchymal imaging with noncontrast CT scan has been the mainstay of imaging. However, as the authors report, there has recently been an increasing use of vessel imaging with CT angiography (CTA). Moving forward, the use of vessel imaging should become routine at most centers. An important new recommendation is that it is reasonable to expect that all Primary Stroke Centers are able to perform CTA on stroke patients, and do so without delaying alteplase administration. The availability of CTA is more widespread, and most community hospitals have the capability to perform CTA in a rapid fashion. As the authors summarize, in most cases, the combination of the noncontrast CT and CTA provides sufficient information to determine eligibility for thrombectomy in the first 6 hours from stroke onset. An additional benefit of performing vessel imaging with CTA at the Primary Stroke Center would be to more efficiently triage transfers for endovascular therapy. In some series, less than half of transferred patients receive thrombectomy because of lack of intracranial vessel occlusion. Such futile transfers are resource intensive and may overwhelm Comprehensive Stroke Centers. We also commend the authors for reaffirming the low incidence of contrast-induced nephropathy, and suggesting that waiting for a serum creatinine should not delay CTA in patients who would be potential thrombectomy candidates.Two important trials, DAWN (Diffusion Weighted Imaging [DWI] or Computerized Tomography Perfusion [CTP] Assessment With Clinical Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention) and DEFUSE-3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3), have shed light on the benefit of mechanical thrombectomy in anterior circulation large-vessel occlusion stroke beyond 6 hours from symptom onset. Both trials showed that in patients who are carefully selected using advanced imaging, using either CT perfusion or magnetic resonance imaging, thrombectomy dramatically improves outcomes even up to 24 hours from onset. These results also have implications for patients at Primary Stroke Centers and Acute Stroke Ready Hospitals. These centers will need to ensure that their workflow can identify potential candidates for thrombectomy beyond 6 hours and rapidly transfer them to a Comprehensive Stroke Center. Again, using CTA at the Primary Stroke Center or Acute Stroke Ready Hospitals to ensure that there is a vessel occlusion before transfer would likely be an optimal workflow and could minimize futile transfers.There has been a palpable shift toward more focused cost-effective recommendations for laboratory and cardiac testing. The message is clear: more is not necessarily better. The new Guideline emphasizes a targeted approach to the diagnostic evaluation and the institution of secondary stroke preventive interventions. Although the role of antiplatelet agents and statins remains relatively unchanged in this update, consideration of dual antiplatelet agents has been added as a new recommendation, albeit with limited evidence.To quote Thoreau, "When any real progress is made, we unlearn and learn anew what we thought we knew before."2 The stroke field has made enormous progress in the past 5 years, and this Guideline will elegantly serve as a primer for updating our knowledge.DisclosuresNone.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to Karen L. Furie, MD, MPH, Rhode Island Hospital, 593 Eddy St, APC-5th Floor, Room 521, Providence, RI 02903. E-mail [email protected]References1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018; 49:e46–e110. doi: 10.1161/STR.0000000000000158.LinkGoogle Scholar2. Torrey B, ed. The Writings of Henry David Thoreau. New York, NY: Houghton Mifflin and Company; 1906.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Woo S, Kim Y and Kim H (2022) The incidence of unexpected delays in uploading outside radiologic images in the transfer of patients with major trauma, Journal of Trauma and Injury, 10.20408/jti.2021.0039, 35:2, (92-98), Online publication date: 30-Jun-2022. Tian B, Tian X, Shi Z, Peng W, Zhang X, Yang P, Li Z, Zhang X, Lou M, Yin C, Zhang Y, Lu J and Liu J (2021) Clinical and Imaging Indicators of Hemorrhagic Transformation in Acute Ischemic Stroke After Endovascular Thrombectomy, Stroke, 53:5, (1674-1681), Online publication date: 1-May-2022.Bai S, Lu X, Pan Q, Wang B, Pong U K, Yang Y, Wang H, Lin S, Feng L, Wang Y, Li Y, Lin W, Wang Y, Zhang X, Li Y, Li L, Yang Z, Wang M, Lee W, Jiang X and Li G (2022) Cranial Bone Transport Promotes Angiogenesis, Neurogenesis, and Modulates Meningeal Lymphatic Function in Middle Cerebral Artery Occlusion Rats, Stroke, 53:4, (1373-1385), Online publication date: 1-Apr-2022. Xie P, Li Y, Alsheikh-Ali A, AlMahmeed W, Shehab A, Sulaiman K, Asaad N, Guo L, Liu S, Zubaid M and Lip G (2022) Symptom Status, Clinical Subtypes, and Prognosis in Patients With Atrial Fibrillation from the Middle East Region (from the Gulf-SAFE Registry), The American Journal of Cardiology, 10.1016/j.amjcard.2021.12.060, 169, (57-63), Online publication date: 1-Apr-2022. Lin S, Chiang P, Chen P, Cheng L, Chen M, Chang P, Lin W and Chen Y (2022) Toward automated segmentation for acute ischemic stroke using non-contrast computed tomography, International Journal of Computer Assisted Radiology and Surgery, 10.1007/s11548-022-02570-x, 17:4, (661-671), Online publication date: 1-Apr-2022. Salgueiro C, Urrútia G and Cabanas-Valdés R Telerehabilitation for balance rehabilitation in the subacute stage of stroke: A pilot controlled trial, NeuroRehabilitation, 10.3233/NRE-210332, (1-9) Lu S, Luo X, Ni X, Li H, Meng M, Cai Y, Liu Y, Ren M, Sun Y and Chen Y (2021) Reporting quality evaluation of the stroke clinical practice guidelines: a systematic review, Systematic Reviews, 10.1186/s13643-021-01805-3, 10:1, Online publication date: 1-Dec-2021. Zhang K, Jin H, Xu R, Zhang P, Guo Z and Yang Y (2021) N-Terminal Pro-brain Natriuretic Peptide Is Associated With Hemorrhagic Transformation and Poor Outcomes in Patients With Stroke Treated With Intravenous Thrombolysis, Frontiers in Molecular Neuroscience, 10.3389/fnmol.2021.758915, 14 Guo Y, Guo X, Zhao K, Bao Q, Yang J and Yang M (2021) Statin Use and Outcomes of Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Systematic Review and Meta-Analysis, Frontiers in Neurology, 10.3389/fneur.2021.734927, 12 Liu Z, Liu D, Guo Z, Jin H, Sun T, Ni C and Yan X (2021) Incidence and Risk Factors of Lower-Extremity Deep Vein Thrombosis After Thrombolysis Among Patients with Acute Ischemic Stroke, Pharmacogenomics and Personalized Medicine, 10.2147/PGPM.S321084, Volume 14, (1107-1114) Liu L, Lu Y, Bi Q, Fu W, Zhou X, Wang J and Wang Q (2021) Effects of Different Intervention Time Points of Early Rehabilitation on Patients with Acute Ischemic Stroke: A Single-Center, Randomized Control Study, BioMed Research International, 10.1155/2021/1940549, 2021, (1-7), Online publication date: 28-Aug-2021. Sharobeam A, Jones B, Walton-Sonda D and Lueck C (2020) Factors delaying intravenous thrombolytic therapy in acute ischaemic stroke: a systematic review of the literature, Journal of Neurology, 10.1007/s00415-020-09803-6, 268:8, (2723-2734), Online publication date: 1-Aug-2021. Savioli G, Ceresa I, Guarnone R, Muzzi A, Novelli V, Ricevuti G, Iotti G, Bressan M and Oddone E (2021) Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to "Access Block", Western Journal of Emergency Medicine, 10.5811/westjem.2021.2.49611, 22:4, (860-870) Yang W, Li Y, Wang Z, Yu T, Xu D, Yang N, Niu X, Cai X, Zhuo W, Wu X, Yan M, Zhou J, Zhang H, Liang Z, Wu W, Cheng J, Huang L, Zhang Y, Guan Y, Tan Z, Lu D, He N, Dong D, Zhu H, Yang B, Shen Q and Xu A (2021) Combined therapy of intensive statin plus intravenous rt-PA in acute ischemic stroke: the INSPIRE randomized clinical trial, Journal of Neurology, 10.1007/s00415-020-10388-3, 268:7, (2560-2569), Online publication date: 1-Jul-2021. Zhong H, Qu J, Xiao W, Chen Y, Liu Y, Wu Z, Qiu D and Liang W (2021) Severity of Lesions Involving the Cortical Cholinergic Pathways May Be Associated With Cognitive Impairment in Subacute Ischemic Stroke, Frontiers in Neurology, 10.3389/fneur.2021.606897, 12 Pan J, Wu G, Yu J, Geng D, Zhang J and Wang Y (2021) Detecting the Early Infarct Core on Non-Contrast CT Images with a Deep Learning Residual Network, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2021.105752, 30:6, (105752), Online publication date: 1-Jun-2021. Ma R, Xie Q, Li H, Guo X, Wang J, Li Y, Ren M, Gong D and Gao T (2021) l-Borneol Exerted the Neuroprotective Effect by Promoting Angiogenesis Coupled With Neurogenesis via Ang1-VEGF-BDNF Pathway, Frontiers in Pharmacology, 10.3389/fphar.2021.641894, 12 Liu Y, Ma J, Shi Q, Xin S, Yu H, Liu Z, Pang C, Dong F and Wang J (2020) Quantitatively monitoring acute ischemic stroke patients post recombinant tissue plasminogen activator treatment, Health Science Reports, 10.1002/hsr2.218, 4:1, Online publication date: 1-Mar-2021. Chung C, Bamodu O, Hong C, Chan L and Chiu H (2021) Application of machine learning-based models to boost the predictive power of the SPAN index, International Journal of Neuroscience, 10.1080/00207454.2021.1881092, (1-11) Hourmant Y, Mailloux A, Valade S, Lemiale V, Azoulay E and Darmon M (2021) Impact of early ICU admission on outcome of critically ill and critically ill cancer patients: A systematic review and meta-analysis., Journal of Critical Care, 10.1016/j.jcrc.2020.10.008, 61, (82-88), Online publication date: 1-Feb-2021. Wang S, Wang C, Wang L and Cai Z Minocycline Inhibits mTOR Signaling Activation and Alleviates Behavioral Deficits in the Wistar Rats with Acute Ischemia stroke, CNS & Neurological Disorders - Drug Targets, 10.2174/1871527319999200831153748, 19:10, (791-799) Zhu H, Jiang L, Zhang H, Luo L, Chen Y and Chen Y (2021) An automatic machine learning approach for ischemic stroke onset time identification based on DWI and FLAIR imaging, NeuroImage: Clinical, 10.1016/j.nicl.2021.102744, 31, (102744), . Xu H, Pang J, Yang X, Yu J, Li X and Zhao D (2020) Modeling clinical activities based on multi-perspective declarative process mining with openEHR's characteristic, BMC Medical Informatics and Decision Making, 10.1186/s12911-020-01323-7, 20:S14, Online publication date: 1-Dec-2020. Zhang K, Rui G, Zhang J, Guo L, An G, Lin J, He W and Ding G (2020) Cathodal tDCS exerts neuroprotective effect in rat brain after acute ischemic stroke, BMC Neuroscience, 10.1186/s12868-020-00570-8, 21:1, Online publication date: 1-Dec-2020. Han B, Sun X, Tong X, Raynald , Jia B, Mo D, Li X, Luo G and Miao Z (2020) Early blood pressure management for endovascular therapy in acute ischemic stroke: A review of the literature, Interventional Neuroradiology, 10.1177/1591019920931651, 26:6, (785-792), Online publication date: 1-Dec-2020. Chung C, Chan L, Bamodu O, Hong C and Chiu H (2020) Artificial neural network based prediction of postthrombolysis intracerebral hemorrhage and death, Scientific Reports, 10.1038/s41598-020-77546-5, 10:1, Online publication date: 1-Dec-2020. Dargazanli C, Zub E, Deverdun J, Decourcelle M, de Bock F, Labreuche J, Lefèvre P, Gascou G, Derraz I, Riquelme Bareiro C, Cagnazzo F, Bonafé A, Marin P, Costalat V and Marchi N (2020) Machine Learning Analysis of the Cerebrovascular Thrombi Proteome in Human Ischemic Stroke: An Exploratory Study, Frontiers in Neurology, 10.3389/fneur.2020.575376, 11 Mendes R, Martins G, Oliveira M, Rocha N, Cruz F, Antunes M, Abreu S, Silva A, Takiya C, Pimentel-Coelho P, Robba C, Mendez-Otero R, Pelosi P, Rocco P and Silva P (2020) Iso-Oncotic Albumin Mitigates Brain and Kidney Injury in Experimental Focal Ischemic Stroke, Frontiers in Neurology, 10.3389/fneur.2020.01001, 11 Tracol C, Vannier S, Hurel C, Tuffier S, Eugene F and Le Reste P (2020) Predictors of malignant middle cerebral artery infarction after mechanical thrombectomy, Revue Neurologique, 10.1016/j.neurol.2020.01.352, 176:7-8, (619-625), Online publication date: 1-Sep-2020. Li X, Du H, Song Z, Wang H, Tan Z, Xiao M and Zhang F (2020) Efficacy and safety of sonothrombolysis in patients with acute ischemic stroke: A systematic review and meta-analysis, Journal of the Neurological Sciences, 10.1016/j.jns.2020.116998, 416, (116998), Online publication date: 1-Sep-2020. AlHarfany H, Haidar L, Cherri S, Malaeb D, Salameh P and Hosseini H (2020) Assessment of acute treatment of hypertension in ischemic stroke patients, Clinical Neurology and Neurosurgery, 10.1016/j.clineuro.2020.105949, 195, (105949), Online publication date: 1-Aug-2020. Wijesundera C, Vingrys A, Wijeratne T and Crewther S (2020) Acquired Visual Deficits Independent of Lesion Site in Acute Stroke, Frontiers in Neurology, 10.3389/fneur.2020.00705, 11 Jacquens A, Guidoux C, Mathon B, Clarençon F and Degos V (2020) Gestione degli accidenti vascolari cerebrali in fase acuta, EMC - Anestesia-Rianimazione, 10.1016/S1283-0771(20)43694-1, 25:2, (1-20), Online publication date: 1-Jun-2020. Scalise M, Brechtel L, Conn Z, Bailes B, Gainey J and Nathaniel T (2020) Predicting ambulatory recovery in acute ischemic stroke patients with thrombolytic therapy, Future Neurology, 10.2217/fnl-2020-0002, 15:2, Online publication date: 1-May-2020. Ni X, Lin H, Li H, Liao W, Luo X, Wu D, Chen Y and Cai Y (2020) Evidence‐based practice guideline on integrative medicine for stroke 2019, Journal of Evidence-Based Medicine, 10.1111/jebm.12386, 13:2, (137-152), Online publication date: 1-May-2020. Jacquens A, Guidoux C, Mathon B, Clarençon F and Degos V (2020) Tratamiento de los accidentes cerebrovasculares en la fase aguda, EMC - Anestesia-Reanimación, 10.1016/S1280-4703(20)43647-3, 46:2, (1-21), Online publication date: 1-May-2020. Schweizer R, Jacquet-Lagrèze M and Fellahi J (2020) Cerebrovascular complications after cardiac surgery: It is time to track and treat large vessel occlusion, The Journal of Thoracic and Cardiovascular Surgery, 10.1016/j.jtcvs.2019.10.147, 159:4, (e263-e264), Online publication date: 1-Apr-2020. Yan X, Liu Z, Guo Z, Sun Y, Jin H, Sun X, Sun H and Yang Y (2020) Positive Influence of Stroke Health Manager on Risk Factors Control and Medication Adherence After Ischemic Stroke, Frontiers in Neurology, 10.3389/fneur.2020.00168, 11 Lee H, Lee E, Ham S, Lee H, Lee J, Kwon S, Kim J, Kim N and Kang D (2020) Machine Learning Approach to Identify Stroke Within 4.5 Hours, Stroke, 51:3, (860-866), Online publication date: 1-Mar-2020. Chung C, Hong C, Huang Y, Su E, Chan L, Hu C and Chiu H (2020) Predicting major neurologic improvement and long-term outcome after thrombolysis using artificial neural networks, Journal of the Neurological Sciences, 10.1016/j.jns.2020.116667, 410, (116667), Online publication date: 1-Mar-2020. Puy L and Jouvent E (2020) Accidente cerebrovascular en el paciente anciano, EMC - Tratado de Medicina, 10.1016/S1636-5410(20)43329-X, 24:1, (1-6), Online publication date: 1-Mar-2020. Young M, Regenhardt R, Leslie-Mazwi T and Stein M (2020) Disabling stroke in persons already with a disability, Neurology, 10.1212/WNL.0000000000008964, 94:7, (306-310), Online publication date: 18-Feb-2020. Zhang M, Hao J, Lin K, Cui Q and Zhang L (2020) Combined surgical and interventional treatment of tandem carotid artery and middle cerebral artery embolus: A case report, World Journal of Clinical Cases, 10.12998/wjcc.v8.i3.630, 8:3, (630-637), Online publication date: 6-Feb-2020. Ottolenghi S, Sabbatini G, Brizzolari A, Samaja M and Chiumello D Hyperoxia and oxidative stress in anesthesia and critical care medicine, Minerva Anestesiologica, 10.23736/S0375-9393.19.13906-5, 86:1 Li X, Wu L, Xie H, Bao Y, He D and Luo X (2019) Endovascular treatment for ischemic stroke beyond the time window: A meta‐analysis, Acta Neurologica Scandinavica, 10.1111/ane.13161, 141:1, (3-13), Online publication date: 1-Jan-2020. Yuan Z, Chen N, Zhou M, Guo J, Zhang Y, Li Y and He L (2020) Effects of hypertension in patients receiving mechanical thrombectomy, Medicine, 10.1097/MD.0000000000019803, 99:16, (e19803) Scheving W, Ebersole J, Froehler M, Moore D, Brown-Espaillat K, Closser J, Self W and Ward M (2020) Implementation of a pilot electronic stroke outcome reporting system for emergency care providers, The American Journal of Emergency Medicine, 10.1016/j.ajem.2019.07.017, 38:1, (114-117), Online publication date: 1-Jan-2020. Luo Y, Yang Y, Xie Y, Yuan Z, Li X and Li J (2019) Therapeutic effect of pre-operative tirofiban on patients with acute ischemic stroke with mechanical thrombectomy within 6–24 hours, Interventional Neuroradiology, 10.1177/1591019919851167, 25:6, (705-709), Online publication date: 1-Dec-2019. Pang J, Xu H, Nan S, Xu S, Li M and Zhao D (2019) A Mobile Intelligent Checklist System for Stroke Emergency 2019 IEEE International Conference on Bioinformatics and Biomedicine (BIBM), 10.1109/BIBM47256.2019.8983379, 978-1-7281-1867-3, (1581-1584) Xu H, Pang J, Yang X, Yu J and Zhao D (2019) A modeling approach based on multi-perspective declarative process mining for clinical activity 2019 IEEE International Conference on Bioinformatics and Biomedicine (BIBM), 10.1109/BIBM47256.2019.8983089, 978-1-7281-1867-3, (1688-1691) Xu G, Dong R, Liu J, Zhao L, Zeng Y, Xiao X, An J, Huang S, Zhong Y, Guang B and Yang T (2019) Synthesis, characterization and in vivo evaluation of honokiol bisphosphate prodrugs protects against rats' brain ischemia-reperfusion injury, Asian Journal of Pharmaceutical Sciences, 10.1016/j.ajps.2018.11.004, 14:6, (640-648), Online publication date: 1-Nov-2019. Ognard J, Dissaux B, Haioun K, Nonent M, Gentric J and Ben Salem D (2019) A "one-stop-shop" 4D CTA protocol using 320-row CT for advanced imaging in acute ischemic stroke: a technical note, European Radiology, 10.1007/s00330-019-06041-x, 29:9, (4930-4936), Online publication date: 1-Sep-2019. Weisenburger-Lile D, Dong Y, Yger M, Weisenburger G, Polara G, Chaigneau T, Ochoa R, Marro B, Lapergue B, Alamowitch S and Elbim C (2019) Harmful neutrophil subsets in patients with ischemic stroke, Neurology - Neuroimmunology Neuroinflammation, 10.1212/NXI.0000000000000571, 6:4, (e571), Online publication date: 1-Jul-2019. Deng L, Qiu S, Wang L, Li Y, Wang D and Liu M (2019) Comparison of Four Food and Drug Administration–Approved Mechanical Thrombectomy Devices for Acute Ischemic Stroke: A Network Meta-Analysis, World Neurosurgery, 10.1016/j.wneu.2019.02.011, 127, (e49-e57), Online publication date: 1-Jul-2019. Johansen M, De Vasconcellos H and Gottesman R (2019) Understanding Atrial Cardiopathy: an Under-Recognized Contributor to Cardioembolic Stroke, Current Treatment Options in Neurology, 10.1007/s11940-019-0571-4, 21:7, Online publication date: 1-Jul-2019. Pollard R, Leppert M, Rawson C, Boehnke M, Honce J, Nagae L, Poisson S and Nyberg E (2019) A Clinical Paradigm for Classifying Neurologic Symptoms to Screen for Emergent Large Vessel Occlusions, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2018.12.010, 28:4, (929-934), Online publication date: 1-Apr-2019. Zhang S, Wang N, Chen L, Zhang P, Shen L, Huang S, Zhang C and Deng B (2019) Serum Aldosterone Is Associated with Cerebral Artery Atherosclerosis and Calcification, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2018.09.053, 28:3, (523-530), Online publication date: 1-Mar-2019. Badve M, Zhou Z, van de Beek D, Anderson C and Hackett M (2018) Frequency of post-stroke pneumonia: Systematic review and meta-analysis of observational studies, International Journal of Stroke, 10.1177/1747493018806196, 14:2, (125-136), Online publication date: 1-Feb-2019. Lee S, Khang Y and Lim H (2019) Impact of the 2015 Middle East Respiratory Syndrome Outbreak on Emergency Care Utilization and Mortality in South Korea, Yonsei Medical Journal, 10.3349/ymj.2019.60.8.796, 60:8, (796), . Schnitzler A, Erbault M, Solomiac A, Sainte Croix D, Fouchard A, May-Michelangeli L and Grenier C (2019) Early rehabilitation after stroke: Strong recommendations but no achievement in the French Acute Healthcare Facilities, Annals of Physical and Rehabilitation Medicine, 10.1016/j.rehab.2018.07.001, 62:1, (58-59), Online publication date: 1-Jan-2019. Liu Z, Zhao Y, Liu D, Guo Z, Jin H, Sun X, Yang Y, Sun H and Yan X (2018) Effects of Nursing Quality Improvement on Thrombolytic Therapy for Acute Ischemic Stroke, Frontiers in Neurology, 10.3389/fneur.2018.01025, 9 Davidson S, Arjun S, Basalay M, Bell R, Bromage D, Bøtker H, Carr R, Cunningham J, Ghosh A, Heusch G, Ibanez B, Kleinbongard P, Lecour S, Maddock H, Ovize M, Walker M, Wiart M and Yellon D (2018) The 10th Biennial Hatter Cardiovascular Institute workshop: cellular protection—evaluating new directions in the setting of myocardial infarction, ischaemic stroke, and cardio-oncology, Basic Research in Cardiology, 10.1007/s00395-018-0704-z, 113:6, Online publication date: 1-Nov-2018. Ma C, Liu S, Zhang S, Xu T, Yu X, Gao Y, Zhai C, Li C, Lei C, Fan S, Chen Y, Tian H, Wang Q, Cheng F and Wang X (2018) Evidence and perspective for the role of the NLRP3 inflammasome signaling pathway in ischemic stroke and its therapeutic potential (Review), International Journal of Molecular Medicine, 10.3892/ijmm.2018.3911 Fong J, Li A and Vohra A (2018) Ischemic stroke of a large vessel requiring endovascular thrombectomy, Visual Journal of Emergency Medicine, 10.1016/j.visj.2018.06.022, 13, (10-11), Online publication date: 1-Oct-2018. Lee H, Kim B, Im S, Hwang S, Jeong J, Chung M, Park J and Shin D (2018) Implications of Mechanical Endovascular Thrombectomy for Acute Basilar and Posterior Cerebral Artery Occlusion, Journal of Cerebrovascular and Endovascular Neurosurgery, 10.7461/jcen.2018.20.3.168, 20:3, (168), . Lee J, Sunwoo J, Kwon K, Roh H, Ahn M, Lee M, Park B, Hyon M and Lee K (2018) Left Ventricular Ejection Fraction Predicts Poststroke Cardiovascular Events and Mortality in Patients without Atrial Fibrillation and Coronary Heart Disease, Korean Circulation Journal, 10.4070/kcj.2018.0115, 48:12, (1148) Ashkanani A, Bitar Z and Maadrani O (2018) Acute stroke thrombolysis in infective endocarditis, SAGE Open Medical Case Reports, 10.1177/2050313X18807629, 6, (2050313X1880762), Online publication date: 1-Jan-2018. March 2018Vol 49, Issue 3 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.118.020176PMID: 29367335 Originally publishedJanuary 24, 2018 KeywordsalgorithmthrombectomycreatinineEditorialsworkflowincidencePDF download Advertisement SubjectsCerebrovascular Disease/Stroke
Referência(s)