Article Figures & Tables
Tables
Characteristic Acute ischemic stroke syndromes Acute coronary syndromes Pathophysiology Heterogeneous: cardioembolic, artery-to-artery embolization, small-vessel disease, cryptogenic or embolic stroke of undetermined source (also known as ESUS) Homogeneous: rupture of plaque and in situ formation of occlusive thrombus (most cases) Diagnosis Clinical; imaging is mandatory and used for treatment decisions Clinical assessment, electrocardiography and imaging used for risk stratification and prognostication Thrombolytics Alteplase (tPA) is standard; other thrombolytic agents still under investigation Tenecteplase is standard; alteplase (tPA), reteplase and streptokinase are alternative proven therapies Endovascular therapy Endovascular thrombectomy proven for patients selected by imaging and with fast treatment paradigms Primary percutaneous coronary intervention established for STEMI, within 12 h of symptom onset Organized care units or wards Associated with proven improvement in mortality and morbidity, but not yet widely established throughout Canada Shown to improve mortality and morbidity; well established worldwide Milder clinical syndromes TIA and minor stroke require same-day assessment, diagnosis and management to prevent major acute stroke Unstable angina and NSTEMI require urgent assessment, diagnosis, risk stratification and often invasive management to prevent major cardiovascular events Note: NSTEMI = non-ST-elevation myocardial infarction, STEMI = ST-elevation myocardial infarction, TIA = transient ischemic attack, tPA = tissue plasminogen activator.
Podcast