Committees  |   December 2018
What’s New: 2018 Stroke Guidelines and Anesthesia Management
Author Affiliations
  • Matthew K. Whalin, M.D., Ph.D.
    Committee on Neuroanesthesia
  • W. Scott Jellish, M.D., Ph.D.
    Committee on Neuroanesthesia
  • A. Elisabeth Abramowicz, M.D.
    Committee on Neuroanesthesia
  • Dorothea S. Rosenberger, M.D., Ph.D.
    Chair, Committee on Neuroanesthesia
Article Information
Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Quality Improvement / Committees
Committees   |   December 2018
What’s New: 2018 Stroke Guidelines and Anesthesia Management
ASA Monitor 12 2018, Vol.82, 42-44.
ASA Monitor 12 2018, Vol.82, 42-44.
During acute ischemic stroke (AIS), the expanding region of irreversibly damaged brain tissue is known as the infarct core. The core is surrounded by the ischemic penumbra, brain tissue that is at risk but salvageable. New imaging techniques identify core and penumbra during AIS and thereby guide patient selection for intervention.
Two recent trials, DAWN and DEFUSE 3, used advanced imaging technology for patients with limited infarct cores who presented much later than six hours after onset. The DAWN trial enrolled patients six to 24 hours since they were last known to be well.1  DEFUSE 3 had broader inclusion criteria for patients presenting six to 16 hours after they were last seen well.2  Both trials showed higher rates of functional independence at 90 days post-stroke for patients who received thrombectomy (>40 percent versus <20 percent). The updated 2018 guidelines recommend thrombectomy for patients presenting between six and 16 hours who meet criteria for either trial.3  Although many patients who present late will not have favorable imaging, these expanded treatment windows will probably lead to an increase in the volume of endovascular stroke procedures.
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