Ischemic stroke therapies

Gonzalez RG (2006) Imaging-guided acute ischemic stroke therapy from time is brain to physiology is brain . AJNR Am J Neuroradiol 27 728-735... 

Zaidat OO, Wolfe T, Hussain SI et al. Interventional acute ischemic stroke therapy with intracranial self-expanding stent. Stroke. 2008 39 2392-2395... 

Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S. Recombinant tissue-type plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study a randomized controlled trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA 1999 282 2019-2026 [see comment]. 

O Connor RE, McGraw P, Edelsohn L. Thrombolytic therapy for acute ischemic stroke why the majority of patients remain ineligible for treatment. Ann Emerg Med 1999 33 9-14. 

Anonymous. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. The NBSfDS t-PA Stroke Study Group. Stroke 1997 28 2109-2118. 

Stroke is the leading cause of major long-term disability in adults and the third leading cause of death in the United States. On average, a new stroke occurs every 45 seconds. Thrombolytic therapy with intravenous recombinant tissue-plasminogen activator (IV rt-PA) is the most effective treatment for acute ischemic stroke. In this chapter, we review the rationale for thrombolysis in acute ischemic stroke, clinical evidence supporting the use of thrombolytics, and the application of thrombolysis in practice. 

Three large randomized trials, the European Cooperative Acute Stroke Study (ECASS) parts I and II, and the Alteplase Thrombolysis for Acute Noninterven-tional Therapy in Ischemic Stroke (ATLANTIS), have investigated the efficacy of IV rt-PA in acute stroke beyond the 3-hour window. All three studies showed high rates of sICH complicating rt-PA treatment, and no overall efficacy of rt-PA. 

Clark WM, Albers GW, Madden KR Hamilton S. The rtPA (alteplase) 0- to 6-hour acute stroke trial, part a (a0276g) results of a double-bhnd, placebo-controlled, multicenter study. Thrombolytic Therapy in Acute Ischemic Stroke Study Investigators. Stroke. 2000 31 811-816. 

Albers GW, Amarenco R Easton JD, Sacco RL, Teal R. Antithrombotic and thrombol3ftic therapy for ischemic stroke The seventh ACCR Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 126 483S-512S. 

Tanne D, Kasner SE, Demchuk AM, Koren-Morag N, Hanson S, Grond M, Levine SR. Markers of increased risk of intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator therapy for acute ischemic stroke in clinical practice The Multicenter rt-PA Stroke Survey. Circulation. 2002 105 1679-1685. 

Thrombolytic therapy with streptokinase in acute ischemic stroke. The Multicenter Acute Stroke Trial-Europe study group. N Engl J Med. 1996 335 145-150. 

Practice advisory Thrombolytic therapy for acute ischemic stroke-summary statement. Report of the quality standards subcommittee of the American Academy of Neurology. Neurology. 1996 47 835-839. 

Grotta JC, Burgin WS, El-MitwaUi A, Long M, Campbell M, Morgenstem LB, Malkoff M, Alexandrov AV. Intravenous tissue-type plasminogen activator therapy for ischemic stroke Houston experience 1996 to 2000. Arch Neurol. 2001 58 2009-2013. 

Heuschmann PU, Berger K, Misselwitz B, Hermanek P, Leffmann C, Adelmann M, Buecker-Nott HI, Rother J, Neundoerfer B, Kolominsky-Rabas PL. Frequency of thrombolytic therapy in patients with acute ischemic stroke and the risk of in-hospital mortality The German Stroke Registers Study Group. Stroke. 2003 34 1106-1113. 

OR 1.81, 95% Cl 1.46-2.24), most of which were related to symptomatic intracranial hemorrhage (OR 3.37, 95% Cl 2.68. 22). In addition, a pooled analysis of six major randomized placebo-controlled IV rt-PA stroke trials (Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) I and II, European Cooperative Acute Stroke Study (ECASS) I and II, and NINDS I and II), including 2775 patients who were treated with IV rt-PA or placebo within 360 minutes of stroke onset, confirmed the beneht up to 3 hours and suggested a potential beneht beyond 3 hours for some patients. The pattern of a decreasing chance of a favorable 3-month outcome as the time interval from stroke onset to start of treatment increased was consistent with the findings of the original NINDS study. ... 

Acute ischemic stroke s3miptoms with onset or last known well, clearly defined. Treatment within 6 h of established, nonfluctuating deficits due to Anterior Circulation (carotid/MCA) stroke, between 6 and 8 h mechanical treatment (e.g.. Concentric Retriever) should be considered. The window of opportunity for treatment is less well defined in posterior circulation (vertebral/basilar) ischemia, and patients may have fluctuating, reversible ischemic symptoms over many hours or even days and stiU be appropriate candidates for therapy. 

Caplan LR, Mohr JP, Kistler JP, Koroshetz W. Should thromboljdic therapy be the first-line treatment for acute ischemic stroke Thrombolysis—not a panacea for ischemic stroke. N Engl J Med 1997 337 1309-1310 [discussion 1313]. 

Lisboa RC, Jovanovic BD, Alberts MJ. Analysis of the safety and efficacy of intraarterial thrombol3ftic therapy in ischemic stroke. Stroke 2002 33 2866-2871. 

Lewandowski CA, Frankel M, Tomsick TA, Broderick J, Frey J, Clark W, Starkman S, Grotta J, Spilker J, Khoury J, Brott T. Combined intravenous and intra-arterial r-TPA versus intra-arterial therapy of acute ischemic stroke Emergency Management of Stroke (EMS) Bridging Trial. Stroke 1999 30 2598-2605. 

Hill MD, Barber PA, Demchuk AM, Newcommon NJ, Cole-Haskayne A, Ryckborst K, Sopher L, Button A, Hu W, Hudon ME, Morrish W, Frayne R, Sevick RJ, Buchan AM. Acute intravenous-intra-arterial revascularization therapy for severe ischemic stroke. Stroke 2002 33 279-282. 

Schellinger PD, Fiebach JB, Hacke W. Imaging-based decision making in thrombolytic therapy for ischemic stroke present status. Stroke 2003 34 575-583. 

Deshmukh VR, Fiorella DJ, Albuquerque FC, Frey J, Flaster M, Wallace RC, Spetzler RF, McDougall CG. Intra-arterial thrombolysis for acute ischemic stroke preliminary experience with platelet glycoprotein Ilb/IIIa inhibitors as adjunctive therapy. Neurosurgery 2005 56 46-54 [discussion 54 5]. 

Abou-Chebl A, Bajzer CT, Krieger DW, Furlan AJ, Yadav JS. Multimodal therapy for the treatment of severe ischemic stroke combining GPEh/IIIa antagonists and angioplasty after failure of thrombolysis. Stroke 2005 36 2286-2288. 

Mohna CA, Saver JL. Extending reperfusion therapy for acute ischemic stroke emerging pharmacological, mechanical, and imaging strategies. Stroke 2005 36 2311-2320. 

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