Critical Care Scenarios Episode 89: Thrombectomy for stroke, with Justin Fraser
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May 14, 2025 
Justin Fraser, a leading expert in cerebrovascular and neuro-interventional surgery, delves into the revolutionary thrombectomy procedure for treating acute ischemic strokes. He shares insights on advancements in technology and patient transfer protocols that optimize outcomes. The discussion also highlights innovative treatments like tenecteplase, the evolution of multidisciplinary collaboration in neurointerventional surgery, and the ethical challenges faced in acute care. Fraser's expertise showcases how evolving practices are reshaping patient care in this critical field.
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Thrombectomy's Strong Evidence Base
- Thrombectomy's effectiveness surpasses many interventions with an estimated number needed to treat around 2.
- Initial skepticism from early trials was overturned by subsequent studies confirming strong benefits.
Optimize Workflow with Imaging Apps
- Use remote imaging apps to instantly review outside hospital imaging and activate transfers rapidly.
- Avoid waiting on phone calls to speed up triage and transfer for thrombectomy candidates.
Continue IV Thrombolytics Pre-Thrombectomy
- Give intravenous thrombolytics like tenecteplase promptly if it won't delay thrombectomy.
- Combining systemic thrombolytics with thrombectomy improves chances of opening up all clots, including small distal ones.