This lecture will discuss the current state of evidence for reperfusion therapies (intravenous thrombolysis and endovascular thrombectomy) in ischemic stroke and future directions. Evidence for delayed window thrombolysis and thrombectomy will be discussed with particular reference to issues around optimal selection of patients for treatment, including advanced brain imaging and large ischemic core in the early and delayed time windows. Expansion of the therapeutic indication for endovascular thrombectomy in mildly affected patients, patients with medium vessel occlusion and basilar artery occlusion will be outlined. Recent trials have challenged the role of intravenous thrombolysis prior to endovascular thrombectomy. These results apply only to patients presenting directly to a thrombectomy capable hospital and the interpretation of these trials will be discussed with reference to standard care workflow and potential future improvements in intravenous thrombolysis. Systems of care to accelerate reperfusion after ischemic stroke are evolving and paramedic severity-based triage, mobile stroke units and optimised imaging workflow will be discussed.
Professor Bruce Campbell MBBS(Hons), BMedSc, PhD, FRACP, FAHMS
Dame Kate Campbell Professorial Fellow
Department of Medicine, University of Melbourne
Consultant Neurologist, Head of Stroke, Interim Head of Neurology
Department of Neurology & Melbourne Brain Centre @ RMH
Royal Melbourne Hospital