ASC Acute Stroke Care & Treatment 3

Question 1

The DAWN and DEFUSE-3 trials extended mechanical thrombectomy eligibility to patients presenting up to how many hours after last known well?

Accepted Answer

24 hours

Answer

The DAWN trial extended thrombectomy to 24 hours using clinical-imaging mismatch criteria, while DEFUSE-3 extended to 16 hours using perfusion imaging.

Question 2

Which imaging modality is MOST useful for identifying the ischemic penumbra (salvageable brain tissue) in late-presenting stroke patients?

Accepted Answer

CT perfusion or MRI perfusion-diffusion mismatch

Answer

CT perfusion or MRI perfusion-diffusion mismatch identifies penumbra (at-risk but viable tissue) versus core infarct for late-window treatment decisions.

Question 3

A 70-year-old patient on warfarin with INR of 1.6 presents with acute ischemic stroke within 3 hours. What is the appropriate tPA decision?

Accepted Answer

Administer tPA — INR < 1.7 is acceptable

Answer

IV tPA may be given to patients on warfarin if the INR is ≤ 1.7, as this level does not confer excessive hemorrhagic risk.

Question 4

What is the recommended door-to-needle time target for IV tPA administration in acute ischemic stroke?

Accepted Answer

60 minutes

Answer

The AHA/ASA recommends a door-to-needle time of ≤ 60 minutes for IV tPA to maximize treatment benefit.

Question 5

Aspirin therapy after acute ischemic stroke treated with IV tPA should be initiated at what time point?

Accepted Answer

At 24 hours post-tPA after repeat CT shows no hemorrhage

Answer

Antiplatelet agents should be withheld for 24 hours after tPA and initiated only after repeat imaging confirms no hemorrhagic transformation.

(ASC) Advanced Stroke Coordinator Certification Practice Test

(ASC) Advanced Stroke Coordinator Certification Practice Test

ASC Acute Stroke Care & Treatment 3