ASTRAL Score for Ischemic Stroke
Predicts 90-day poor outcome in patients with acute ischemic stroke.
Use in patients with acute ischemic stroke admitted within 24 hours of stroke onset.
When to Use
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- Acute ischemic stroke is a neurological emergency that is amenable to time-sensitive treatments (e.g. tPA, mechanical thrombectomy) if certain clinical conditions are met.
- Neurological consultation should be obtained immediately in suspected cases of acute ischemic stroke.
- Should not be used as a substitute for clinical judgment and is intended for use as an adjunct to medical decision-making.
- In cases of suspected ischemic stroke, the following is recommended:
- STAT neurological consultation.
- STAT CT head without contrast.
- STAT laboratory testing (complete blood count, PT/INR/aPTT, basic metabolic panel, type & screen, troponin-I).
- Consider STAT CT angiogram of the head & neck in cases of suspected large-vessel occlusion (LVO) presenting in the acute setting.
- Intravenous tissue plasminogen activator (IV tPA) is the standard-of-care treatment for adult patients presenting with acute ischemic stroke within 4.5 hours of symptom onset, if no exclusion criteria are met.
- Mechanical thrombectomy is the standard-of-care treatment for selected adult patients presenting with acute ischemic stroke due to LVO presenting in the acute setting.
- Note that the appropriateness of patient for endovascular intervention depends on multiple factors, such as time since onset, neuroimaging, baseline functional status, and others.
- Appropriateness for intravenous thrombolysis or mechanical thrombectomy should be determined by neurological/neurosurgical consultant whenever available.
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