Podcast Episode Details

Large Vessel Occlusions (LVO)

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Episode 2

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First and foremost, we would like to thank all pre-hospital providers for the work you do. You are all underpaid, understaffed, and under appreciated. However, the unsung work that you do matters now more than ever. We go to work every day in order to be there when the public needs us. Much of the focus as of late has been on COVID. And probably rightfully so. But patients continue to have MI’s, strokes, overdoses and many other emergencies. And these emergencies still deserve our excellent care and diligence not to miss. So although we plan to have another special-edition, COVID-update episode we don’t want to neglect these other emergencies. So let's talk about Large Vessel Occlusions.

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Ep. 2 Large Vessel Occlusion (LVO) Show Notes

 

First and foremost we would like to thank all prehospital providers for the work you do. You are all underpaid, understaffed, and under appreciated. However, the unsung work you do now more than ever matters. We go to work every day in order to be there when the public needs us. Much of the focus as of late has been on COVID. And probably rightfully so. But that being said, patients continue to have MI’s, strokes, overdoses and many other emergencies. And these emergencies too still deserve our excellent care and diligence not to miss. So although we plan to have another special edition COVID update episode soon we don’t want to neglect these other emergencies. This month we talk Large Vessel Occlusions.

• Endovascular Stroke therapy (EST) for large vessel occlusion (LVO) - This is the hottest therapy since PCI - 12 studies since 2013, 5 studies in 2015 alone 
  • https://rebelem.com/endovascular-therapy-for-acute-ischemic-stroke-the-new-shiny-toy-in-stroke-care/
  • For a nice review of all of the studies and evolution of endovascular therapy visit:

 

• How is EST performed? 
  • A catheter is guided through one of the femoral arteries and up through the carotid and into the distal internal carotid, anterior cerebral artery or the middle cerebral artery
  • A clot retrieval device is fed through the catheter in order to retrieve the clot
  • Unlike tPA which has only shown very marginal benefit in just a few studies that were admittedly methodologically flawed. EST has recently had multiple strongly positive trials showing impressive benefits (although these benefits are likely over estimated, see the link above for a deep dive on the researches strengths and weaknesses)

 

• Who Qualifies for EST?
  • Similar to the early days of PCI for myocardial infarctions when cath lab centers were farer and fewer between
  • Will likely vary based on your stroke center and may change with future studies so make sure you stay up to date with your local protocols.
    • Initial studies looked at less than 6 hour time window and is what the American stroke guidelines currently recommend. 
    • A lot of places have started pushing this time window further out and locally here we us a cut off of less than 24 hours
  • Initially studies for all comers with stroke receiving EST found no benefit
  • It wasn’t until they id

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    Published on 5 years, 8 months ago