Ischemic Stroke

Continual Transcranial Ultrasound Monitoring of blood flow through the Middle Cerebral artery following the example of Continous Glucose Monitoring Scanning is a Futuristic option awaiting development .
Reference :Evaluation of age -related white matter changes using Transcranial Doppler Ultrasonography : Xiong YY J Neuroimging Jan 23 (1) 53-7 MokV et al : Transcranial Doppler Ultrasound for screening small vessel disease : a community study Stroke 2012 Oct;43(10)2791-3
Studies have shown that the length of the clot in the Middle Cerebral artery can be measured as can the position of the clot proximal or distal and that IV tpa for long proximal clots greater than 20mm have very poor reperfusion and recovery rates .
These cases ought have immediate triage to thrombectomy as the procedure develops in acuity .
Reference : Clot Length Distribution and Predictors in Anterior Circulation Stroke :Implications for IA therapy Kamalian S et al Stroke 2013 Dec ;44(12) 3553-3556

Great review. I'm interested in learning what information you give to patients to help in shared decision making about receiving tPA. I've heard multiple statistics from different neurologist and have read different statistics in a variety of papers, from no benefit and some harm on theNNT website, to seemingly impossible improvement listed in papers such as Assessment and Improvement of Figures to visually Convey benefit and risk, and a Cochrane review which gives odds ratios which are difficult for patients to understand. I fully understand the complexity of heterogeneous studies, outcomes, trials stopped early, statistical trickery etc, but we have to be able to give patients and families some kind of information other than our own opinions which I feel are generally pessimistic toward benefit.

what are you doing with the patients on plavix? special considerations to those on plavix and coumadin with inr less than 1.7