Smacc

Ryan Radecki urges you to rethink the acute management of stroke. The current way of thinking about stroke and the acute treatment has been around for decades. In this time, a lot has changed, new technologies have been developed and we have learnt a lot about the underlying physiology of stroke. Endovascular therapy, CT perfusion, and patient-level predictive modelling are now all at the disposal of clinicians. Moreover, Ryan wonders if we are using the current treatments – namely tPA – more safely or effectively. In acute stroke management there are two key factors to consider. Successful reperfusion and salvageable tissue. To restore and save brain tissue one must successfully re-perfuse the tissue. The classic method for achieving this is by using tPA. However, Ryan contends that this is akin to using a sledgehammer to fix a teacup. It is a dangerous drug, with many risks, and it is not appropriate for all patients. Salvageable tissue is the second key factor. If brain tissue is dead, it stays dead. It do