Canadian best practice recommendations for stroke care (updated 2008)

Lindsay, Patty; Bayley, Mariana; Hellings, Chelsea; Hill, Michael D.; Woodbury, E.; Phillips, S.

doi:10.1503/cmaj.081148.r2

Cited by 203 publications

(176 citation statements)

References 29 publications

(2 reference statements)

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“…In general, pediatric AIS current guidelines recommend avoidance of thrombolytic therapy and mechanical interventions because of lack of safety data. 21,22 However, increasingly children, some younger than school age, are being treated with mechanical endovascular approaches or vertebral artery surgery [23][24][25][26] despite significant risks with these approaches in ischemic stroke. 27,28 Because of the safety concerns, which are potentially amplified in children, it follows that such treatments should be reserved for situations where a compelling case can be made.…”

Section: Discussionmentioning

confidence: 99%

Basilar artery strokes in children: good outcomes with conservative medical treatment

Lagman-Bartolome

Pontigon

Moharir

et al. 2013

Develop Med Child Neuro

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Aim To describe outcomes and outcome predictors in childhood basilar artery stroke (BAS). Method We prospectively enrolled children with BAS with or without basilar artery occlusion (BAO) in the Toronto Children's Stroke Registry from 1992 to 2009. We assessed presenting features and outcomes including Pediatric Stroke Outcome Measure scores. Results Among 578 children with acute arterial ischemic stroke, 27 had BAS (4.6% including neonates, 6% excluding neonates). Twenty‐four (14 males, 10 females) children met study criteria (mean age at stroke was 8y 10mo; range 0–17y). Eleven children had BAO. Aspirin or anticoagulation was given to 15 children. None received tissue plasminogen activator or endovascular treatments. At mean follow‐up (3y 2mo, range 1mo–11y 8mo), 12 had a ‘good outcome’ (seven normal, five insignificant deficit) and 12 had ‘poor outcome’ (10 moderate or severe deficit, two acute deaths). Larger infarct size (≥50% of axial brainstem diameter) independently predicted poor outcome (p=0.02; odds ratio 21.2, 95% confidence interval 1.6–274.9) but not BAO, altered level of consciousness, or age. Interpretation Compared with adults, in childhood BAS death is rare and survivors frequently have good outcomes. Aggressive endovascular interventions may not be justifiable in this population.

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Section: Discussionmentioning

confidence: 99%

Basilar artery strokes in children: good outcomes with conservative medical treatment

Lagman-Bartolome

Pontigon

Moharir

et al. 2013

Develop Med Child Neuro

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“…During thrombus retrieval, suction through a balloon guide catheter in the relevant internal carotid artery was also recommended. The control group received the current standard of care as described in the Canadian or local guidelines for the management of acute stroke 30,31 (see the Methods section in the Supplementary Appendix). Participants in both groups received intravenous alteplase within 4.5 hours after the onset of stroke symptoms if they met accepted local guidelines for intravenous alteplase treatment.…”

Section: Treatmentsmentioning

confidence: 99%

Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke

et al. 2015

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“…Current guidelines recommend that all patients receive treatment within 60 minutes of arrival. 22 For every minute that the middle cerebral artery remains blocked, an estimated 1.9 million neurons and 12 kilometres of axons are destroyed. 23 Thus, one can argue even 60 minutes is too long a wait, and we have called for a concerted national effort to reduce in-hospital times to 30 minutes or less.…”

Section: Cmaj Openmentioning

confidence: 99%