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

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RAIN 2018: Ischemic Stroke

Wade S. Smith, MD, PhD

Chief, UCSF Neurovascular Division Professor, UCSF Department of Neurology

Disclosures

• NIH
• U10 NS 086494 (PI) NorCal RCC
• Consultant or stock ownership:
• DSMB: Stryker Inc.

Wade S. Smith, MD, PhD

Chief, UCSF Neurovascular Division Professor, UCSF Department of Neurology MR CLEAN REVASCAT SWIFT-Prime EXTEND IA ESCAPE N=1287 Randomized Patients

5 10 7.9 16.9 13.6 19.1 5 10 15 20 25 30 35 40 45 50

Control Intervention

Percent

Good Outcomes

1 2

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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

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

Albers, et al, Epub NEJM January 24, 2018 Albers, et al, Epub NEJM January 24, 2018

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Albers, et al, Epub NEJM January 24, 2018

Outcomes by Time

27 13 17 46 49 45 10 20 30 40 50 60 HERMES DAWN DEFUSE-3 Control Thrombectomy

IV t-PA effect? Ischemic Creep?

Late Window Paradox

Albers, Stroke: 2017 ePub

UCSF Acute Stroke Protocol

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2018 UCSF Acute Stroke Protocol

Major Conclusions

• Embolectomy with stent retrievers improve clinical
• utcome 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