Simple and Swift Acute Ischemic Stroke Therapy based on Cases and Evidence: Possibilities of Cost Reduction and Improving Global Access
Main Article Content
Abstract
There have been significant improvement in the care of acute ischemic stroke (AIS) resulting in reducing death and improving outcomes. Numerous groundbreaking positive randomized controlled trials have demonstrated that strokes with large vessel occlusion (LVO) treated with endovascular mechanical thrombectomy (EVMT) with standard treatment are associated with much better outcomes compared to those treated only with standard therapy. Additional evidence also revealed that the positive outcomes continue to persists for stroke patients with large vessels occlusion if they are treated with 24 hours of symptoms including those with wake-up stroke. The evidence suggests that for every two-patient treated with EVMT, one patient can be saved, which is the highest evidence in the medicine surpassing acute myocardial infarction and other acute lifesaving therapies. Based on these evidence, the local, National and International organizations have updated the guidelines in the treatment of AIS which have remarkably strengthen the process, pathways and standards for acute ischemic stroke management in the developed countries. However, not much progresses have made in the developing and third-world countries for stroke therapies, because of cost, affordability and there are no third-party payers. Most recent trials have further discovered that stroke patient with LVO and a large core volume treated with endovascular perfusion therapy in conjunction with standard treatment do significantly better comparted to standard treatment alone. New trials have also demonstrated that stroke patients undergoing EVMT with or without thrombolytic have equal functional outcome. Additional evidence suggests that non-disabling stroke patients treated with dual antiplatelet have equal functional outcome with less bleeding risk compared to intravenous thrombolysis. These evolving evidences have provided us with the opportunities to simplify the algorithm and treatment of acute ischemic stroke, which not only will cutdown time by eliminating unnecessary steps and redundant therapies, but also will reduce the healthcare cost and improving global access, specially, countries where patients bear the costs. In this review, author presents real life stroke patients treated based on recent evidence and provides with a simple and swift algorithm, that will reduce time to perfusion therapy and will make treatment affordable globally.
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