Indications for and opportunities provided by recanalization therapy of cerebral ischaemia, intravenous thrombolysis
Authors:
D. Krajíčková
Authors‘ workplace:
Neurologická klinika LF a FN Hradec Králové
Published in:
Čes Ger Rev 2009; 7(2): 57-62
Overview
Reperfusi on is the most benefici al of all therape utical strategi es for acute ischemic stroke. Reperfusi on therapi es salvage penumbral tissue, reduce final infarct size, and enable improved clinical o utcomes. Beca use of the risk of hemorrhage, especi ally in the brain, thrombolytic therapy is restricted by guidelines with the large amo unt of the inclusi on and exclusi on criteri as adopted from the randomised clinical tri als, and only a small number of the pati ents are being tre ated. Some restricti ons lack sci entific basis. Now it is a right time for new insights. Combined intraveno us and intraarteri al recanalizati on (farmacological and mechanical) therapy appe ars safe and its benefit is currently under investigati on.
Keywords:
acute ischemic stroke – recanalizati on therapy – intraveno us thrombolysis – combined therapy – guidelines – criteri as for therapy
Sources
1. Bonita R. Epidemi ological studi es and the preventi on of stroke. Cerebrovasc Dis 1994; 4 (suppl 1): 2– 10.
2. Gillum RF, Sempos CT. The end of the long‑term decline in stroke mortality in the United States? Stroke 1997; 28: 1527– 1529.
3. Tissue plasminogen activator for acute ischemic stroke. The Nati onal Institute of Ne urological Disorders and Stroke rt- PA Stroke Study Gro up. N Engl J Med 1995; 333: 1581– 1587.
4. Wardlaw JM, Sandercock PA, Berge E. Thrombolytic therapy with recombinant tissue plasminogen activator for acute ischaemic stroke: where do we go from here? A cumulative meta‑analysis. Stroke 2003; 34: 1437– 1442.
5. Hacke W, Albers G, Al- Rawi Y et al. The Desmoteplase in Acute Ischaemic Stroke Tri al (TRIAL): a phase II MRI‑based 9- ho ur window acute stroke thrombolysis tri al with intraveno us desmoteplase. Stroke 2005; 36: 63– 73.
6. Katzan IL, Hammer MD, Furlan AJ et al. Cleveland Clinic He alth System Stroke Qu ality Improvement Te am. Qu ality improvement and tissue‑type plasminogen activator for acute ischemic stroke: a Cleveland update. Stroke 2003; 34: 799– 800.
7. Katzan IL, Furlan AJ, Lloyd LE et al. Use of tissue‑type plasminogen activator for acute ischemic stroke: the Cleveland are a experi ence. JAMA 2000; 283: 1151– 1158.
8. Bateman BT, Schumacher HC, Boden- Albala B et al. Factors associ ated with in‑hospital mortality after administrati on of thrombolysis in acute ischemic stroke pati ents. An analysis of the Nati onwide Inpati ent Sample 1999 to 2002. Stroke 2006; 37: 440– 446.
9. Caplan LR. Tre atment of acute stroke. Still struggling. JAMA 2004; 292: 1883– 1885.
10. Lee KY, Han SW, Kim SH et al. Early recanalizati on after intraveno us administrati on of recombinant tissue plasminogen activator as assessed by pre‑ and post‑thrombolytic angi ography in acute ischemic stroke pati ents. Stroke 2007; 38: 192– 193.
11. Ba umann CR, Ba umgartner RW, Gandjo ur J et al. Go od o utcomes in ischemic stroke pati ents tre ated with intraveno us thrombolysis despite regressing ne urological symptoms. Stroke 2006; 37: 1332– 1333.
12. Smith EE, Abdullah AR, Petkovska I et al. Po or o utcomes in pati ents who do not receive intraveno us tissue plasminogen activator beca use of mild or improving ischemic stroke. Stroke 2005; 36: 2497– 2499.
13. Rha JH, Saver JL. The impact of recanalizati on on ischemic stroke o utcome: a meta‑analysis. Stroke 2007; 38: 967– 973.
14. De Keyser J, Gdovinová Z, Uyttenbo ogaart M et al. Intraveno us alteplase for stroke. Beyond the guidelines and in particular clinical situ ati ons. Stroke 2007; 38: 2612– 2618.
15. Molina CA, Saver JL. Extending reperfusi on therapy for acute ischemic stroke. Emerging pharmacological, mechanical, and imaging strategi es. Stroke 2005; 36: 2311– 2320.
16. Hacke W, Kaste M, Bluhmki E et al. Thrombolysis with alteplase 3 to 4.5 ho urs after acute ischemic stroke. N Engl J Med 2008; 359: 1317– 1329.
17. Mattle HP. Intraveno us or intra- arteri al thrombolysis? It’s time to find the right appro ach for the right pati ent. Stroke 2007; 38: 2038– 2040.
18. Shaltoni HM, Albright KC, Gonzales NR et al. Is intra- arteri al thrombolysis safe after full‑dose intraveno us recombinant tissue plasminogen activator for acute ischemic stroke? Stroke 2007; 38: 80– 84.
19. IMS II Tri al Investigators. The Interventi onal Management of Stroke (IMS) II Study. Stroke 2007; 38: 2127– 2135.
20. Krajina A, Krajíčková D, Lojík M et al. Endovaskulární léčba při ischemických cévních mozkových příhodách. In: Krajina A, Peregrin JH, Beran J (eds). Intervenční radi ologi e. Miniinvazivní terapi e. Praha: Auri us 2005: 382– 396.
21. Murphy BD, Fox AJ, Lee DH et al. Identificati on of penumbra and infarct in acute ischemic stroke using computed tomography perfusi on- derived blo od flow and blo od volume me asurements. Stroke 2006; 37: 1771– 1777.
22. Parsons MW, Pepper EM, Bateman GA et al. Identificati on of the penumbra and infarct core on hyperacute noncontrast and perfusi on CT. Ne urology 2007; 68: 730– 736.
23. Schaefer PW, Roccatagli ata L, Ledezma C et al. First- pass qu antitative CT perfusi on identifi es thresholds for salvage able penumbra in acute stroke pati ents tre ated with intra- arteri al therapy. AJNR Am J Ne uroradi ol 2006; 27: 20– 25.
24. Schaefer PW, Barak ER, Kamali an S et al. Qu antitative assessment of core/ penumbra mismatch in acute stroke. CT and MR perfusi on imaging are strongly correlated when suffici ent brain volume is imaged. Stroke 2008; 39: 2986– 2992.
25. Schramm P, Schellinger PD, Fi ebach JB et al. Comparison of CT and CT angi ography so urce images with diffusi on- weighted imaging in pati ents with acute stroke within 6 ho urs after onset. Stroke 2002; 33: 2426– 2432.
26. Schramm P, Schellinger PD, Klotz E et al. Comparison of perfusi on computed tomography and computed tomography angi ography so urce images with perfusi on- weighted imaging and diffusi on- weighted imaging in pati ents with acute stroke of less than 6 ho urs’durati on. Stroke 2004; 35: 1652– 1658.
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Geriatrics General practitioner for adultsArticle was published in
Czech Geriatric Review
2009 Issue 2
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