New Guidelines Could Increase Access to Crucial Treatments for Stroke

According to research released at the ASA’s International Stroke Conference 2018, new guidelines for treating acute ischemic stroke significantly increase the window for mechanical clot removal, from 6 hours to 24 hours—likely increasing the number of patients who will have access to the treatment.

“The expanded time window for mechanical thrombectomy for appropriate patients will allow us to help more patients lower their risk of disability from stroke,” William J Powers, MD, the guideline writing group chair and professor of neurology at the University of North Carolina, said. “That’s a big deal. That’s potentially a lot more people who could benefit, and it has completely changed the landscape of acute stroke treatment.”

The guideline was recently published in Stroke, and was authored by a team of clinicians using the most recent research available. They based the new recommendations on review of over 400 peer-reviewed studies. 

The guidelines specifically expand the window for mechanical thrombectomy, a procedure that removes or dissolves blood clots, to 24 hours for patients with clots in large vessels supplying the brain. The guidelines recommend that mechanical thrombectomy typically only be performed within 16 hours of a stroke; however, the 24-hour option can be used for some patients based on advanced brain imaging.

Additionally, the ASA has created a new, Thrombectomy-Capable Stroke Center, certification level for hospitals that meet very high standards for performing mechanical endovascular thrombectomy.

Other recommendations in the newly published guidelines include increased access to another procedure, known as alteplase administration. This procedure is an IV clot-busting, tissue plasminogen activator, drug that is administered to patients to dissolve clots after a stroke. The new guidelines recommend that doctors can now administer this drug to patients who had mild strokes, after weighing the risks and benefits of the drug against the patient’s condition. 

“It potentially increases the number of people getting the intravenous clot-busting treatment,” Dr Powers said in a press release.

The guidelines also add a new telehealth or video-conferencing recommendation for health systems that do not have clinicians trained to use clot-dissolving medication. They recommend connecting with “telestroke” providers to improve access and the quality of care. 

The “2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke,” update a previous version published in Stroke in 2013.

—David Costill