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Thrombolysis for cerebral ischemia.

Fugate JE, Giraldo EA, Rabinstein AA - Front Neurol (2010)

Bottom Line: Time from symptom onset to thrombolysis is the most important determinant of the success of treatment, with greatest efficacy if given within 90 min.Hospitals should implement standardized processes and protocols for acute stroke to guide immediate patient assessment, brain imaging, drug administration, and post-thrombolysis care.In this article we review the clinical application of thrombolysis, care of acute stroke patients, current evidence regarding fibrinolysis, and future direction of penumbral imaging to select candidates for reperfusion therapies.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Mayo Clinic Rochester, MN, USA.

ABSTRACT
The care for patients with acute ischemic stroke has been revolutionized by the clinical application of fibrinolysis. Intravenous recombinant tissue plasminogen activator (rt-PA) has been proven to improve functional outcomes following acute ischemic stroke and can be administered to a select group of patients up to 4.5 h after symptom onset. Time from symptom onset to thrombolysis is the most important determinant of the success of treatment, with greatest efficacy if given within 90 min. Hospitals should implement standardized processes and protocols for acute stroke to guide immediate patient assessment, brain imaging, drug administration, and post-thrombolysis care. In this article we review the clinical application of thrombolysis, care of acute stroke patients, current evidence regarding fibrinolysis, and future direction of penumbral imaging to select candidates for reperfusion therapies.

No MeSH data available.


Related in: MedlinePlus

CT perfusion scan of the head demonstrates findings consistent with large ischemic penumbra. Decreased cerebral blood flow (A), preserved cerebral blood volume (B), and prolonged time to peak (C) and mean transit time (D) in the left middle cerebral and bilateral anterior cerebral artery distributions are shown.
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Figure 3: CT perfusion scan of the head demonstrates findings consistent with large ischemic penumbra. Decreased cerebral blood flow (A), preserved cerebral blood volume (B), and prolonged time to peak (C) and mean transit time (D) in the left middle cerebral and bilateral anterior cerebral artery distributions are shown.

Mentions: There is strong physiological rationale to support the concept that imaging of the ischemic penumbra with MRI diffusion-weighted (DWI) and perfusion-weighted (PWI) or CT perfusion (CTP) can extend the therapeutic window for reperfusion therapies, including fibrinolysis. Proponents of this model argue that documentation of persistent ischemic penumbra (i.e., hypoperfused but salvageable tissue) should represent a solid indication for reperfusion treatments regardless of duration of symptoms. A comparison of CTP sequences of mean transit time, cerebral blood flow, and cerebral volume may identify whether there is salvageable ischemic penumbra or if the infarct has been completed (Figure 3). Assuming that brain imaging can reliably recognize penumbral tissue and discriminate patients at excessive risk for bleeding in the infarct core, the concept should be valid. However, these assumptions remain to be proven.


Thrombolysis for cerebral ischemia.

Fugate JE, Giraldo EA, Rabinstein AA - Front Neurol (2010)

CT perfusion scan of the head demonstrates findings consistent with large ischemic penumbra. Decreased cerebral blood flow (A), preserved cerebral blood volume (B), and prolonged time to peak (C) and mean transit time (D) in the left middle cerebral and bilateral anterior cerebral artery distributions are shown.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3008863&req=5

Figure 3: CT perfusion scan of the head demonstrates findings consistent with large ischemic penumbra. Decreased cerebral blood flow (A), preserved cerebral blood volume (B), and prolonged time to peak (C) and mean transit time (D) in the left middle cerebral and bilateral anterior cerebral artery distributions are shown.
Mentions: There is strong physiological rationale to support the concept that imaging of the ischemic penumbra with MRI diffusion-weighted (DWI) and perfusion-weighted (PWI) or CT perfusion (CTP) can extend the therapeutic window for reperfusion therapies, including fibrinolysis. Proponents of this model argue that documentation of persistent ischemic penumbra (i.e., hypoperfused but salvageable tissue) should represent a solid indication for reperfusion treatments regardless of duration of symptoms. A comparison of CTP sequences of mean transit time, cerebral blood flow, and cerebral volume may identify whether there is salvageable ischemic penumbra or if the infarct has been completed (Figure 3). Assuming that brain imaging can reliably recognize penumbral tissue and discriminate patients at excessive risk for bleeding in the infarct core, the concept should be valid. However, these assumptions remain to be proven.

Bottom Line: Time from symptom onset to thrombolysis is the most important determinant of the success of treatment, with greatest efficacy if given within 90 min.Hospitals should implement standardized processes and protocols for acute stroke to guide immediate patient assessment, brain imaging, drug administration, and post-thrombolysis care.In this article we review the clinical application of thrombolysis, care of acute stroke patients, current evidence regarding fibrinolysis, and future direction of penumbral imaging to select candidates for reperfusion therapies.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Mayo Clinic Rochester, MN, USA.

ABSTRACT
The care for patients with acute ischemic stroke has been revolutionized by the clinical application of fibrinolysis. Intravenous recombinant tissue plasminogen activator (rt-PA) has been proven to improve functional outcomes following acute ischemic stroke and can be administered to a select group of patients up to 4.5 h after symptom onset. Time from symptom onset to thrombolysis is the most important determinant of the success of treatment, with greatest efficacy if given within 90 min. Hospitals should implement standardized processes and protocols for acute stroke to guide immediate patient assessment, brain imaging, drug administration, and post-thrombolysis care. In this article we review the clinical application of thrombolysis, care of acute stroke patients, current evidence regarding fibrinolysis, and future direction of penumbral imaging to select candidates for reperfusion therapies.

No MeSH data available.


Related in: MedlinePlus