November 2007

Expanded Window for Stroke Therapy

S. Andrew Josephson, M.D.
UCSF Neurology and Neurovascular Service

Acute ischemic stroke refers to strokes caused by thrombosis or embolism and accounts for 85 percent of all strokes. Options for acute stroke therapy have recently expanded to include treatments that are effective up to eight hours after symptom onset.

This expanded therapeutic window for acute ischemic stroke (out to eight hours from last time patient was seen normal) allows for a much greater number of patients to be eligible for acute therapies. UCSF Medical Center routinely accepts patients in emergent transfer who present too late to receive IV t-PA, but are within the window for catheter-based therapies, such as mechanical embolectomy.

This technique uses novel catheter devices to remove rather than dissolve the offending clot, making it pivotal to saving ischemic brain from infarction. Such devices offer alternative therapy to patients who cannot receive thrombolytics and also can be used in combination with thrombolytics to safely restore cerebral perfusion. These treatments are only available at select Joint Commission -accredited stroke centers, such as UCSF Medical Center, where experts are at the forefront of this field.

When evaluating a patient with acute stroke, the key question involves determining the last time the patient was seen completely normal, which marks the onset of their stroke. One common mistake is to over estimate how much time remains in a patient's treatment window. As all treatments are time-based, this last time normal serves to determine which therapies the patient is eligible to receive. A head CT excluding hemorrhage should be obtained in all patients prior to acute therapy.

Treatment options

Treatment options for acute ischemic stroke include:
  • 0-3 hours after onset — Intravenous tissue-plasminogen activator (t-PA)
  • 0-6 hours after onset — Intra-arterial t-PA administered during a catheter-based cerebral angiogram
  • 0-8 hours after onset — Mechanical embolectomy used during a catheter-based cerebral angiogram

For more information, contact the Physician Referral Service at UCSF Medical Center:

Phone (888) 689-UCSF or (888) 689-8273

Other Resources

UCSF Neurovascular Disease and Stroke Center
UCSF Pediatric Stroke and Cerebrovascular Disease Center
UCSF Stroke Center Certification
Perinatal Strokes