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(Stroke. 2008;39:261.)
© 2008 American Heart Association, Inc.

Advances in Stroke 2007

Advances in Critical Care and Emergency Medicine 2007

From the Neurological Intensive Care Unit, Departments of Neurology and Neurosurgery, Columbia University Medical Center, New York, NY (S.A.M.); and the Department of Neurology, University of Erlangen, Erlangen, Germany (S.S.).

Correspondence to Stephan A. Mayer, MD, FCCM, Neurological Institute, 710 W 168th St, Box 39, New York, NY 10032. E-mail sam14@columbia.edu

Key Words: critical care • emergency medicine

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The emergency room is the front line in the battle against stroke. In 2007 the results of 2 phase III international stroke trials were announced: DIAS-2 evaluated IV recombinant tissue plasminogen activator (rtPA) within an expanded time window based on the demonstration of MR perfusion-diffusion mismatch, and FAST was designed to confirm the clinical benefits of early hemostatic therapy with recombinant activated factor VII (rFVIIa) for intracerebral hemorrhage (ICH). These trials promised to usher in a new era of therapy for thousands of acute stroke victims in our emergency departments. Unfortunately, both trials were negative. On the brighter side, however, a meta-analysis of 3 European hemicraniectomy trials for middle cerebral artery (MCA) infarction showed a powerful mortality reduction. These studies have established hemicraniectomy with duroplasty as the treatment of choice for younger patients (<60 years) admitted to intensive care with medically refractory edema and intracranial pressure related to MCA infarction.

Hemostatic Therapy for ICH: The FAST Trial

ICH is widely recognized as the deadliest and least treatable form of stroke. Thus, it was with great anticipation that the results of the FAST trial were announced at the European Stroke Congress in Glasgow in the spring of 2007. FAST was designed to confirm the strikingly positive results of an earlier phase IIB trial investigating the effects of rFVIIa on hematoma expansion in the acute phase of ICH. In addition to an approximate 50% reduction in ICH volume growth, 3 doses of rFVIIa (40, 80, and 160 µg/kg) were collectively associated with a statistically significant 38% mortality reduction, as . . . [Full Text of this Article]