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Practice Buzz: How do you manage acute ischemic stroke?


Practice Current and Practice Buzz Surveys are intended to assess neurologic practice around the world. There are no right answers in this survey. We include topics that are controversial or limited evidence is available. Additionally, many external factors may affect practice (insurance, access to medication, etc.). We are interested in capturing the variability of real-life practice. While recognizing each case is different, please choose the answer that best reflects your TYPICAL practice and limit free text to strategies that are not included.

This survey pertains to your practices, knowledge, and beliefs regarding management of patients presenting with acute ischemic stroke with large vessel occlusion (LVO). The survey is intended for neurologists (physicians and advanced practice providers) who care for adult patients with stroke and transient ischemic attack in the inpatient settings.

Estimated Time: 6 Minutes

Research team: Nishita Singh, MD and Aravind Ganesh, MD, DPhil

Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) are both approved and widely used therapies in acute ischemic stroke with large vessel occlusion(1). Although EVT became a standard of care since 2015, recent trials like DIRECT-MT, MR CLEAN NO-IV and others(2), have questioned whether this new treatment should replace or complement IVT. In addition, alteplase has been the traditional approved thrombolytic of choice for use in ischemic stroke. However, some parts of the world have shifted to use tenecteplase for a variety of pharmacologic and economic reasons(3, 4). The AcT trial which was recently presented at an international stroke conference showed that tenecteplase (0.25mg/kg) is non-inferior to alteplase in patients with acute ischemic stroke presenting within 4.5h of symptom onset and the effect size was larger in patients who presented with large vessel occlusion in favor of tenecteplase. NORTEST 2 (part A) was yet another trial presented but the study used a higher dose of tenecteplase (0.4mg/kg) and was terminated early due to safety concerns(5). We seek to understand current practices around the world for treating acute ischemic stroke with large vessel occlusion.

1. How much of your clinical time is spent in the care of patients with acute stroke? *This question is required.
2. What is your current role? *This question is required.