Hyperacute Stroke in the ED

In this episode, Matthew and Elizabeth interview Dr Sohil Pothiawala and Dr Nijanth M Raj about hyperacute stroke in the Emergency Department. Ever wondered what was the evidence behind the time cut-offs for thrombolysis, tried to recall all the relative and absolute contraindications for thrombolysis, or wondered what was the optimal blood pressure for your patient and which anti-hypertensive to choose? Tune in to find out more! 

Timestamps

02:52 NINDS trial

04:20 ECASS III trial 

04:59 RTPA absolute (ABCDES mnemonic) and relative contraindications, pearls and pitfalls 

08:44 BP targets and preferred antihypertensives for BP control 

10:03 Permissive Hypertension 

12:22 Alteplase vs Tenecteplase (AcT trial, TIMELESS trial, ETERNAL-LVO trial) 

16.27 Thrombectomy (EXTEND IA trial, MR CLEAN trial, SWIFT PRIME trial, DAWN & DEFUSE-3 trials)

18.08 LVO (Large Vessel Occlusion) 

20:25 Basilar strokes/ Posterior Circulation Strokes

24:33 Combining Thrombolysis and EVT 

27:05 WAKE-UP trial

28:52 More on the DAWN & DEFUSE-3 trials

30:39 What works for shortening door to intervention times? 

32.40 What’s on the horizon? 

Credits

Music: Life-line by Colorful Sound via Pixabay/ SGH Podcast Studio

References

1. Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Acute Ischemic Stroke. Ann Emerg Med. 2023 Aug;82(2):e17-e64. doi: 10.1016/j.annemergmed.2023.03.007.
2. American College of Emergency Physicians Clinical Policies Subcommittee (Writing Committee) on Thrombolytics; Lo BM et al. Clinical Policy: Use of Thrombolytics for the Management of Acute Ischemic Stroke in the Emergency Department. Ann Emerg Med. 2024 Dec;84(6):e57-e86. doi: 10.1016/j.annemergmed.2024.07.023. PMID: 39578010.

Note: This episode was recorded in 2025.

https://semspodcast.buzzsprout.com/