Page 166 - Hospital Authority Convention 2017

Symposiums Symposiums
HOSPITAL AUTHORITY CONVENTION 2017

SS4.1 Recent Advances in Acute Ischaemic Stroke Management 09:00 Theatre 2

Recent Advances in Acute Ischaemic Stroke Management
Tse MMY
Department of Medicine, Queen Mary Hospital, Hong Kong
Three most important evidence-based new advances in acute ischaemic stroke (AIS) management include: (1) introduction of
stroke unit; (2) the use of intravenous (IV) thrombolysis; and (3) intra-arterial (IA) mechanical thrombectomy in eligible patients.
Efficacy of IV recombinant tissue plasminogen activator (rtPA) in treating patients with AIS presented within three hours
from onset was first proven in 1995. Over the following 20 plus years, this practice changing evidence leads to significant
changes in hospital systems especially in the emergency work flow logistic; all aim to facilitate its delivery and to shorten the
door to needle (DTN) time. Percentage of AIS patients benefited from IV thrombolysis has increased steadily from about 2%
to over 15% in some countries. These are the results of enhanced hospital work flow logistics and relaxation of various non
evidence-based restrictions on IV rtPA use.

Despite these efforts, there are various restrictions on IV rtPA use and its efficacy in treating patients with large vessel
occlusion (LVO) is generally poor. Only about 10% of patients with ICA and 20% to 30% with proximal middle cerebral artery
occlusion responded favourably with IV therapy. IA mechanical thrombectomy is targeted to improve clinical outcome in
this subgroup of patients. Evidence in 2015 strongly supported endovascular therapy in treating this subgroup of patients.
Meta-analysis of the five most recently published randomised control trials showed that IA therapy has an absolute benefit
of 20% over IV therapy alone. The average number needed to treat is five for one patient to achieve functional independence.
In response to these overwhelming bodies of evidence, the US and EU have updated its AIS management guidelines that
advocating IA therapy should be offered to eligible patients with LVO and appropriate measures should be taken to optimise
current hospital pathway so that IA therapy can be delivered promptly.

SS4.2 Recent Advances in Acute Ischaemic Stroke Management 09:00 Theatre 2

Mechanical Thrombectomy in Acute Stroke – Radiologist’s Perspective
Lee R
Department of Radiology, Queen Mary Hospital, Hong Kong

Intra-arterial thrombectomy is currently an option for treatment of acute ischemic stroke within six hours of symptom onset
Wednesday, 17 May the hospital where patient admitted? Posterior circulation ischaemic stroke? In-hospital stroke? Computed tompgraphy on
(Class 1; Level A). How to implement this service is indeed a great challenge.
Who should lead the team? Who should perform the procedure? Drip and ship to comprehensive stroke centre or treated in
brain, angiography alone or do we need additional imaging modalities? General anaesthesia or monitoring anaesthetic care?
Should we treat in octogenarian ? Hardware arrangement?

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