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Medical Therapy for Ischemic Stroke: Review of Intravenous and Intra-Arterial Treatment Options
Author(s):
Philipp Taussky
,
Rabih G. Tawk
,
Wilson P. Daugherty
,
Ricardo A. Hanel
Publication date
Created:
December 2011
Publication date
(Print):
December 2011
Journal:
World Neurosurgery
Publisher:
Elsevier BV
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Abstract
Thrombolytic therapy is of proven and substantial benefit for select patients with acute cerebral ischemia. Diagnostic options and medical treatment options for acute stroke ischemia have undergone enormous changes in the past decades. Whereas initially stroke treatment was reduced to prevention, management of symptoms, and rehabilitation, nowadays a multitude of different fibrinolytic drugs are available. The wide availability of computed tomography in the late 1980s made thrombolysis a real therapeutic option because it allowed a fast and accurate differentiation between ischemic and hemorrhagic stroke. This study reviews these developments and how they have shaped our current use and understanding of thrombolytics in the treatment of acute ischemic stroke. Patient selection remains a central aspect of thrombolytic treatment, and to date, the use of different fibrinolytics has been studied in over 20 large randomized trials for different clinical settings, time windows, and routes of administration. These studies included over 7000 patients, and led to our current understanding of the use of thrombolysis in acute stroke. Intravenous fibrinolytic therapy within the first 3 hours of ischemic stroke onset offers substantial benefits for virtually all patients with potentially disabling deficits. In the 3- to 4.5-hour treatment window, intravenous fibrinolytic therapy has been shown to offer moderate net benefits when applied to all patients with potentially disabling deficits. Intra-arterial fibrinolytic therapy in the 3- to 6-hour window offers moderate net benefits when applied to all patients with potentially disabling deficits and large-artery cerebral thrombotic occlusions. Copyright © 2011 Elsevier Inc. All rights reserved.
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Stroke MRI
Author and article information
Journal
Title:
World Neurosurgery
Abbreviated Title:
World Neurosurgery
Publisher:
Elsevier BV
ISSN (Print):
18788750
Publication date Created:
December 2011
Publication date (Print):
December 2011
Volume
: 76
Issue
: 6
Pages
: S9-S15
Article
DOI:
10.1016/j.wneu.2011.05.048
PubMed ID:
22182278
SO-VID:
dc7d2ee1-ce54-40c5-bb04-71493d3690a9
Copyright ©
© 2011
License:
https://www.elsevier.com/tdm/userlicense/1.0/
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