Episode 2: Acute Stroke Management: The Lowdown
Author: Eoghan Colgan @eoghan_colgan
Special Guest: Prof. Keith Muir
Professor Keith Muir
Professor Keith Muir is SINAPSE Chair of Clinical Imaging (Stroke and Brain imaging) and a consultant neurologist at the Queen Elizabeth University Hospital in Glasgow.
Main scientific interests include the application of advanced brain imaging to clinical trials as a tool for translational research, and he has led trials of thrombolysis (ATTEST, ATTEST-2, WAKE-UP), thrombectomy (co-chief investigator of PISTE trial), physiological management (SELESTIAL), stem cell therapy (PISCES 1 and 2, the first use of human neural stem cells in clinical studies), and novel imaging methods (PRACTISE).
His work is undertaken predominantly in the South Glasgow Acute Stroke Service which has the highest rates of IV thrombolytic therapy in the UK and in the top 10 in Europe.
Eoghan and Prof. Muir discuss the latest evidence and theory around the acute management of strokes - thrombolysis (and a reaction to the skepticism), thrombectomy and others. Many thanks to Prof. Muir for his insights.
Take Home Messages
- The stroke community are very satisfied with thrombolysis and are somewhat perplexed by the skepticism from some corners.
- Future research will aim to refine the correct agent and dose and how to deliver it more quickly as well as refining how to better choose the right patients who will benefit based on better imaging modalities
- Thrombectomy is exciting but there are a number of logistical hurdles to overcome. It will be confined to specialist centres and thrombolysis will remain the treatment of choice for the majority
- TIA's are being increasingly seen as high-risk events and steps are being taken to assess and treat more urgently
- The old definition (resolution <24hrs) is probably inaccurate and most TIA's typically resolve within a matter of minutes or few hours at most. Therefore few TIA's are thrombolysed.
A comprehensive (and skeptical) overview with further links to others
Professor Muir's university page with an overview of his research