Acute ischemic stroke treatment has changed a lot during the last decades: intravenous thrombolysis and mechanical thrombectomy have been established, the time window has been widened. Still, only 10-20% of all ischemic stroke patients are eligible for an acute reperfusion treatment or are treated, respectively. Here, several issues arise: Patient selection and treatment selection remain challenging: many patients still arrive too late at the hospital, multimodal neuroimaging may not be available or adverse events compromise treatment effects.
The aim of this Research Topic is to cover all aspects of limitations in acute ischemic stroke treatment, such as time window, availability of advanced neuroimaging, stroke care organization and education, promising treatment options, and patient selection. For example, patient selection based on NCCT / ASPECTS may be a promising and effective way for hospitals without the availability of multimodal neuroimaging including perfusion imaging to select patients for reperfusion treatment. Tenecteplase may be associated with favorable outcome and less bleeding complications compared to alteplase. Organizational changes and training were associated with faster patient allocation. Education may help to increase awareness of stroke symptoms. Secondary deterioration is associated with poor outcome. However, treatment options still remain challenging since the availability of reliable predictors is limited. The risk of adverse events of reperfusion treatment increases with time since onset. A possible effective prevention, an optimal patient selection, or novel treatment options may increase the net-efficacy of reperfusion treatment.
We call upon this Research Topic to improve patient selection and thrombolysis/mechanical thrombectomy rate especially in situations not covered by guidelines or RCTs and to improve treatment and prevention of adverse events with or without reperfusion treatment.
Manuscripts with the following themes are especially welcome:
• Patient selection: advanced/multimodal neuroimaging vs. NCCT scans
• Acute reperfusion treatment and time window beyond 4.5/6/9/24 hours
o Patient selection (How to select the right patient for the right treatment?)
o Secondary deterioration (How to deal with early/late secondary deterioration?)
o Pre-hospital / in-hospital organization and education (How to get patients earlier/faster to the hospital and to treatment?)
• Thrombolysis: alteplase vs. tenecteplase
• Factors associated with adverse events of reperfusion treatment and treatment options.
This Research Topic welcomes original research articles, short reports, reviews, and meta-analyses.
Conflicts of Interest: Dr. Volbers reports grants from Institutional grant (Inselspital), and personal fees from Pfizer AG/Bristol-Myers Squibb SA, Bayer AG, Ipsen Pharma, and CSL Behring. Dr. Kallmünzer reports personal fees from Pfizer AG/Bristol-Myers Squibb SA, Bayer AG, Medtronic, and Daiichi Sankyo. Dr. Seiffge reports funding from Swiss Heart Foundation, Swiss National Science Foundation, Bangerter-Rhyner Foundation, Bayer Foundation, Portola/Alexion; and he's also member of the advisory board of Bayer Switzerland AG, Portola/Alexion, and VarmX.
Acute ischemic stroke treatment has changed a lot during the last decades: intravenous thrombolysis and mechanical thrombectomy have been established, the time window has been widened. Still, only 10-20% of all ischemic stroke patients are eligible for an acute reperfusion treatment or are treated, respectively. Here, several issues arise: Patient selection and treatment selection remain challenging: many patients still arrive too late at the hospital, multimodal neuroimaging may not be available or adverse events compromise treatment effects.
The aim of this Research Topic is to cover all aspects of limitations in acute ischemic stroke treatment, such as time window, availability of advanced neuroimaging, stroke care organization and education, promising treatment options, and patient selection. For example, patient selection based on NCCT / ASPECTS may be a promising and effective way for hospitals without the availability of multimodal neuroimaging including perfusion imaging to select patients for reperfusion treatment. Tenecteplase may be associated with favorable outcome and less bleeding complications compared to alteplase. Organizational changes and training were associated with faster patient allocation. Education may help to increase awareness of stroke symptoms. Secondary deterioration is associated with poor outcome. However, treatment options still remain challenging since the availability of reliable predictors is limited. The risk of adverse events of reperfusion treatment increases with time since onset. A possible effective prevention, an optimal patient selection, or novel treatment options may increase the net-efficacy of reperfusion treatment.
We call upon this Research Topic to improve patient selection and thrombolysis/mechanical thrombectomy rate especially in situations not covered by guidelines or RCTs and to improve treatment and prevention of adverse events with or without reperfusion treatment.
Manuscripts with the following themes are especially welcome:
• Patient selection: advanced/multimodal neuroimaging vs. NCCT scans
• Acute reperfusion treatment and time window beyond 4.5/6/9/24 hours
o Patient selection (How to select the right patient for the right treatment?)
o Secondary deterioration (How to deal with early/late secondary deterioration?)
o Pre-hospital / in-hospital organization and education (How to get patients earlier/faster to the hospital and to treatment?)
• Thrombolysis: alteplase vs. tenecteplase
• Factors associated with adverse events of reperfusion treatment and treatment options.
This Research Topic welcomes original research articles, short reports, reviews, and meta-analyses.
Conflicts of Interest: Dr. Volbers reports grants from Institutional grant (Inselspital), and personal fees from Pfizer AG/Bristol-Myers Squibb SA, Bayer AG, Ipsen Pharma, and CSL Behring. Dr. Kallmünzer reports personal fees from Pfizer AG/Bristol-Myers Squibb SA, Bayer AG, Medtronic, and Daiichi Sankyo. Dr. Seiffge reports funding from Swiss Heart Foundation, Swiss National Science Foundation, Bangerter-Rhyner Foundation, Bayer Foundation, Portola/Alexion; and he's also member of the advisory board of Bayer Switzerland AG, Portola/Alexion, and VarmX.
