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      Acute Ischemic Stroke: Management Approach

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          Abstract

          How to cite this article: Chugh C. Acute Ischemic Stroke: Management Approach. Indian J Crit Care Med 2019;23(Suppl 2):S140–S146.

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          Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

          Tudor G Jovin, Raul Nogueira, Ashutosh Jadhav … (2018)
          The effect of endovascular thrombectomy that is performed more than 6 hours after the onset of ischemic stroke is uncertain. Patients with a clinical deficit that is disproportionately severe relative to the infarct volume may benefit from late thrombectomy.
          Article 0 comments Cited 1065 times – based on 0 reviews     Review now
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            Thrombectomy for Stroke at 6 to 16 Hours with Selection by Perfusion Imaging

            Gregory W Albers, Michael Marks, Stephanie Kemp … (2018)
            New England Journal of Medicine, 378(8), 708-718
            Article 0 comments Cited 958 times – based on 0 reviews     Review now
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              Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomized controlled trial. Prolyse in Acute Cerebral Thromboembolism.

              A Furlan, R. Higashida, L. Wechsler … (1999)
              Intravenous tissue-type plasminogen activator can be beneficial to some patients when given within 3 hours of stroke onset, but many patients present later after stroke onset and alternative treatments are needed. To determine the clinical efficacy and safety of intra-arterial (IA) recombinant prourokinase (r-proUK) in patients with acute stroke of less than 6 hours' duration caused by middle cerebral artery (MCA) occlusion. PROACT II (Prolyse in Acute Cerebral Thromboembolism II), a randomized, controlled, multicenter, open-label clinical trial with blinded follow-up conducted between February 1996 and August 1998. Fifty-four centers in the United States and Canada. A total of 180 patients with acute ischemic stroke of less than 6 hours' duration caused by angiographically proven occlusion of the MCA and without hemorrhage or major early infarction signs on computed tomographic scan. Patients were randomized to receive 9 mg of IA r-proUK plus heparin (n = 121) or heparin only (n = 59). The primary outcome, analyzed by intention-to-treat, was based on the proportion of patients with slight or no neurological disability at 90 days as defined by a modified Rankin score of 2 or less. Secondary outcomes included MCA recanalization, the frequency of intracranial hemorrhage with neurological deterioration, and mortality. For the primary analysis, 40% of r-proUK patients and 25% of control patients had a modified Rankin score of 2 or less (P = .04). Mortality was 25% for the r-proUK group and 27% for the control group. The recanalization rate was 66% for the r-proUK group and 18% for the control group (P<.001). Intracranial hemorrhage with neurological deterioration within 24 hours occurred in 10% of r-proUK patients and 2% of control patients (P = .06). Despite an increased frequency of early symptomatic intracranial hemorrhage, treatment with IA r-proUK within 6 hours of the onset of acute ischemic stroke caused by MCA occlusion significantly improved clinical outcome at 90 days.
              Article 0 comments Cited 177 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Crit Care Med
                Journal ID (iso-abbrev): Indian J Crit Care Med
                Journal ID (publisher-id): IJCCM
                Title: Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
                Publisher: Jaypee Brothers Medical Publishers
                ISSN (Print): 0972-5229
                ISSN (Electronic): 1998-359X
                Publication date (Print): June 2019
                Volume: 23
                Issue: Suppl 2
                Pages: S140-S146
                Affiliations
                [1]Department of Interventional Neurology, MAX Saket Hospital, New Delhi, India
                Author notes
                Chandril Chugh, Department of Interventional Neurology, MAX Saket Hospital, New Delhi, India, e-mail: chandrilchugh@ 123456gmail.com
                Article
                DOI: 10.5005/jp-journals-10071-23192
                PMC ID: 6707502
                PubMed ID: 31485123
                SO-VID: f1b46598-07bf-437b-a1de-db7f9f79d71b
                Copyright © Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.
                License:

                This work is licensed under a Creative Commons Attribution 4.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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                Categories
                Subject: Neurocritical Care

                ScienceOpen disciplines: Emergency medicine & Trauma
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                ScienceOpen disciplines: Emergency medicine & Trauma

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