ORIGINALLY PUBLISHED AUGUST 15, 2024
Stroke Alert August 2024
- Negar Asdaghi, MD, MSc
- Eric D. Goldstein, MD
- Nastajjia Krementz, MD
Gang Li: OK. Firstly, in patients with suspected stroke in the ambulance, intensive blood pressure lowering within 2 hours of symptoms onset should not be recommended in routine practice currently. For hemorrhagic stroke, INTERACT4 is the first randomized evidence for effects of intensive blood pressure lowering on functional outcomes. Time is also important for treatment for hemorrhagic stroke. Policies and the workflows should be modified to initiate blood pressure lowering treatment as soon as possible after diagnosis of hemorrhagic stroke. For ischemic stroke, it is harmful to control the elevated blood pressure before the perfusion therapy. We should reconsider optimal blood pressure management in hyperacute ischemic stroke.
Next step, the most important plan is to show how to detect hemorrhagic stroke in the ambulance, such as mobile stroke unit with CT scan. However, mobile stroke unit is very, very expensive. We are searching for devices and tests for intracerebral hemorrhage diagnosis in the ambulance, such as blood test, ultrasound, little device, mini CT, and others. In the future, Professor Craig and I have a plan to keep this collaboration in ambulance drug trial to find the proper test for the diagnosis of intracerebral hemorrhage that can be used in routine practice.
Dr. Negar Asdaghi: Gang, very, very important points, and I want to again highlight this. INTERACT4 showed that intensive reduction of blood pressure in patients with stroke-like symptoms that have motor deficit and are very, very early on from their symptom onset should not be implemented in routine care because there is evidence of harm for patients who ultimately will have an acute ischemic stroke, but there is absolute evidence of benefit for patients with intracerebral hemorrhage. And unless we have ways by which we can distinguish between these two important subtypes on route to the hospital, we should not implement blood pressure reduction measures. You highlighted some of the efforts in the field, including some of your efforts to try to come up with either ambulance CT scan mobile units, which are a bit difficult to get and pricey. Perhaps, the hope of having a blood test, which is everyone's hope, mini CTs, ultrasound machines. I think the sky is not the limit of what possibilities are out there to differentiate between a scan, blood, no blood. And if there is indeed blood, then blood pressure needs to be reduced.
Professor Gang Li, it's been really a great pleasure speaking with you, and thank you for joining us all the way from Shanghai.
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