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Ischemic Stroke

Ischemic Stroke

Ischemic Stroke

FOAMEd Wiki - Ischemic Stroke, last updated 4/16/25

Workup and Guidelines

Workup	Source	Year
Acute Ischemic Stroke	IBCC	2022
Acute Ischemic Stroke Part 1	EMCrit	2022
Acute Ischemic Stroke Part 2	EMCrit	2022
VAN Score for LVO	RebelEM	2018

Posterior CVA	Source	Year
Posterior Circulation Strokes and Dizziness: Pearls and Pitfalls	emDocs	2017
Posterior Circulation Strokes: Why do we miss them, and how do we improve?	emDocs	2020
Posterior Circulation Stroke	CoreEM	2019

Protocols, Workflows, and Guidelines	Source	Year
2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke	AHA / ASA	2018
2021 Guideline for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack	AHA / ASA	2021
Acute Ischemic Stroke – Spoon-Feed Version	JournalFeed $	2020
Mobile Stroke Units - multi-center RCT	SGEM	2021
SGEM290: Neurologist-Led Stroke Teams Working 9 to 5	SGEM	2020

Thrombolytic & Antiplatelet Therapy

Thrombolytic Positive Trials	Source	Year
NINDS I-II	WikiJournalClub	2015
ECASS III	WikiJournalClub	2017
TheNNT V2 (systematic review)	TheNNT	2019

Lytic Debate	Source	Year
TPA - NNT v1	The NNT	2013
The Secret of NINDS (Thrombolysis for Acute Stroke)	SGEM	2014
Thrombolytics for Stroke	First10EM	2017
Thrombolysis for Acute Ischemic Stroke - No Retreat, No Surrender	SGEM	2019
Thrombolysis in Acute Ischemic Stroke: Now We Have No Positive RCTs (NINDS II & ECASS Revisited)	REBEL EM	2020
tPA Advocates Be Like – Never Gonna Give You Up (NINDS II & ECASS Revisted)	SGEM	2020
NINDS II and ECASS III Revisited - ACEP	ACEP	2020
TPA - NNT v3 (Systematic Review)	The NNT	2021
Thrombolytics for Acute Ischemic Stroke: Review of NNT v3	First10EM	2021

Lytic Contraindications	Source	Year
tPA Contraindications for Ischemic Stroke	MDCalc
Are Thrombolytics Safe for Acute Ischemic Strokes in Patients on DOACs?	ALiEM	2022

Timing	Source	Year
Door-to-TPA Under 20 Minutes	JournalFeed $	2018
MRI-Guided Thrombolysis for Unknown Time of Onset	JournalFeed $	2018
Extending the TPA Window to 4.5–9 Hours	REBEL EM	2019
Extending the TPA Window to 9 Hours	JournalFeed $	2019
Extending the TPA Window - The Case of the Magician's Sleight	EMCrit	2019
Rebel Cast Ep92: Alteplase for Unknown Last Known Well	REBEL EM	2020
Rebellion21: Alteplase for Stroke of Unknown Time of Onset	REBEL EM	2021
SGEM325: Thin Ice - MRI-Guided Thrombolysis	SGEM	2021

Dosing	Source	Year
tPA (Alteplase) Dosing for Ischemic Stroke Calculator	MDCalc
Tenecteplase (TNK) Dosing for Ischemic Stroke Calculator	MDCalc
EXTEND-IA TNK Part II - TNK dose	REBEL EM	2020

Alteplase (TPA) vs. Tenecteplase	Source	Year
Tenecteplase vs Alteplase Before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK)	Core EM	2018
Tenecteplase vs. Alteplase in Acute Ischemic Stroke	REBEL EM	2022
You Don't Have to Act That Way: TNK for Stroke	SGEM	2022

Antiplatelet Therapy	Source	Year
PRISMS Trial: Alteplase vs. Aspirin in Minor Stroke	REBEL EM	2018
PRISMS Trial - TPA vs. ASA in Mild CVAs	JournalFeed $	2018
Thales Trial - DAPT for CVA/TIA	SGEM	2020
Ischemic CVA - THALES - ASA + Ticagrelor	REBEL EM	2020
The ARAMIS Trial: DAPT vs. Alteplase in Minor Stroke	REBEL EM	2023

LVO & Neuroendovascular Therapy

General Evidence & Protocols	Source	Year
Diagnosis and Neurointerventional Management of Large Vessel Occlusion Acute Ischemic Stroke	emDocs	2022
Endovascular Therapy for Acute Ischemic Stroke	REBEL EM	2018
Ep 120 ED Stroke Management in the Age of Endovascular Therapy	EM Cases	2019
Interventional Therapy for Stroke: The Evidence	First10EM	2017
Endovascular Stroke Treatment Review	JournalFeed $	2019

Time Window	Source	Year
52 in 52 – #39: DAWN – Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct	emDocs	2023
DAWN - 6 to 24 Hours after Stroke with a Mismatch Between Deficit and Infarct	The Bottom Line	2018

EVT vs. EVT + tPA – Comparative Trials	Source	Year
The DIRECT-MT Trial: Are Systemic Lytics Necessary in LVO Treatment?	REBEL EM	2020
REBEL Cast Ep 105: Thrombolysis Before Endovascular Therapy for LVO Acute Ischemic Stroke	REBEL EM	2021
SGEM#333: Do You Gotta Be Starting Something – Like tPA Before EVT?	SGEM	2021
The DEVT + SKIP Trials: Does Systemic Thrombolysis Prior to Endovascular Treatment Improve Outcomes in Large Vessel Occlusion Strokes?	REBEL EM	2021
MR CLEAN-NO IV: Endovascular Treatment for Stroke Compared to Alteplase Followed by Endovascular Treatment: No Difference, But Also Not Not Worse	REBEL EM	2022

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